Sequential Intercept Model: Best Practices

I0-01 · Use Alternatives to the Criminal Justice System

Communities with the strongest outcomes do not lean on a single program. They build a connected set of crisis response options so that officers, dispatchers, and families have somewhere to turn besides arrest or the emergency department. The basic shape is simple: someone to call, someone to respond, and a safe place to go. This section is the umbrella; the five response models that follow (stabilization/diversion centers, mobile crisis teams, co-responders or peer respite) are the pieces that fit inside it.

Descriptions of integrated crisis systems point in a consistent direction. Where call triage, mobile response, and clinical receiving locations are connected rather than run as three separate programs, communities report declines in arrests, emergency department (ED) visits, and repeat crises. No single piece appears to carry that result on its own. What appears to matter most is the handoff between pieces, and whether law enforcement trusts the system enough to use it by default rather than as an exception.

In Texas, Bexar County's coordinated infrastructure is the most established example, with documented reductions in jail utilization. Oklahoma's statewide investment in crisis-system capacity offers a state-level reference, with reductions in jail bookings and significant cost savings. Both are useful points of contact for communities building from the ground up.

A single unreliable component can undermine the rest. Where dispatch cannot route the call, where mobile response is slow, or where the drop-off door is not open, officers tend to default to what they know.

I0-02 · Crisis Receiving and Stabilization Centers

Crisis receiving and stabilization centers are open-door facilities where officers, EMS providers, or walk-ins can bring someone in acute behavioral health crisis for rapid intake and short-term stabilization. Most people are stabilized and discharged within 24-hours with follow-up arrangements in place. The features that make the model successful are simple: law enforcement can drop someone off in minutes rather than hours, and the facility takes everyone regardless of acuity, insurance, or intoxication.

These centers reliably reduce jail bookings and ED overcrowding, and the clearest effect in the research is on hospital use and length of stay. The direct arrest-reduction case is emerging. The often-cited Miami-Dade figure (about 109 arrests across 50,000 crisis calls over five years) comes from system reporting, not a controlled study. But officers consistently say the fast handoff is what makes the model work in practice, and without it they stop bringing people.

San Antonio's Restoration Center is the most widely known Texas example and the model most other Texas counties reference.

The circumstances under which these centers lose traction are fairly predictable. Wait times grow. Exclusion criteria tighten. Capacity does not keep pace with demand. Any of these can lead officers to stop using the center, and once they stop, rebuilding the habit tends to take longer than building it the first time.

I0-03 · Mobile Crisis Teams (Clinician-Led)

Mobile crisis teams (MCT) send a behavioral health clinician, often paired with a Certified Peer Specialist, directly to the scene of a behavioral health call. In this model the clinician leads the encounter, and officers may provide safety support without serving as the primary responder. Arrest reduction is the outcome most often associated with that configuration. Swanson and colleagues (2025), in the first head-to-head comparison of mobile crisis, co-response, and police-only response in Michigan, found significantly fewer arrests in the 11 months following an MCT dispatch than after a police-only response. The National Survey of Mobile Crisis Teams (Goldman et al., 2023) reports that teams resolve a majority of behavioral health calls on the scene without further escalation. Better follow-up linkage to outpatient care is also reported in the earlier literature, with the caveat that Peters and colleagues (2025), in the one systematic review on point, describe that evidence base as tentative and call for randomized trials.

Denver's STAR initiative is the most widely studied clinician-led model in the country, with documented reductions in low-level arrests. Houston's Crisis Call Diversion Program is a Texas MCT model. Eugene, Oregon's CAHOOTS is the longest-running clinician-led crisis response team in the U.S. and a potential model for rural and small-metro communities.

One caution is worth planning around. Where the clinician can respond but no clinical destination is available, the impact of the intervention may be substantially reduced. Staffing is a related constraint, and counties in rural areas often report difficulty recruiting clinicians available for this work.

I0-04 · Co-Responder Programs

Co-responder programs send an officer and a behavioral health clinician together to a crisis call, where the clinician leads the behavioral health engagement and the officer handles safety.

Co-responder teams reliably reduce involuntary psychiatric detentions, increase awareness of community resources among people in crisis and their families, and reduce future crisis calls. The evidence on arrest and ED-visit reduction is more mixed: some programs show effects and some do not, with outcomes depending heavily on the design choices below.

For counties considering co-response, measuring local arrest outcomes directly is one way to resolve that uncertainty. The model tends to function as a supplement to the broader system rather than a replacement for it.

I0-05 · Peer-Run Crisis Respite

Peer respites are short-term, non-clinical, home-like settings staffed entirely by people with lived experience of mental illness or substance use recovery. Typical stays run 5 to 14 days. The focus is connection, de-escalation, and stabilization, and they often serve as a voluntary alternative to the ED or an inpatient unit for people who might engage with peers but not with clinical settings.

Croft and İsvan (2015) found that peer-run crisis respite guests were about 70% less likely to use inpatient or ED services afterward than similar non-users. Different programs have reported between 30 to 63% reductions in inpatient days and 24 to 47% reductions in total behavioral-health costs. The consumer-experience data (people feeling heard, respected, more in control) is consistently stronger than in clinical comparison settings. There is no randomized trial yet, but the pattern of effects across sites is striking.

Thresholds' Living Room in Chicago is one of the best-known models and a good phone call for program design. Peer respites also operate in Delaware, Michigan, and Florida. Texas has not scaled the model widely, but the state's ongoing investment in peer support through LMHAs and crisis services provides a foundation to adapt from.

A respite that operates quietly on its own may not reach the people who could benefit most. The other constraint to plan for is workforce. Access to peer certification programs for local residents is a recurring limitation, and difficulty recruiting and training peers is among the most common reasons these programs fall short of their potential.

I0-06 · Community Paramedicine

Community paramedicine extends the role of EMS. Paramedics receive additional training so they can respond to lower-acuity calls, do home visits with frequent EMS users, and connect people to services without automatically transporting to an ED. The model is particularly attractive in rural counties that cannot sustain a clinician-led mobile crisis team.

Agarwal and colleagues (2024) report improved health engagement and reduced EMS call volume among frequent users. Pilot data from rural jurisdictions suggest real reductions in avoidable ED visits, in the range of 14 to 40%.

Programs in Alameda County, California have documented decreases in non-urgent ED transports and stronger coordination with behavioral health. In Texas, the Department of State Health Services maintains information on community paramedicine implementation around the state. Paired with telehealth back-up, this is one of the more promising rural Texas pilots.

Paramedics without referral options become another ride. Isolation from the local behavioral health system turns the program into transport with extra training. The model needs the same back-end capacity that mobile crisis teams need.

I0-08 · Expand Access to Housing

For people with serious mental illness, housing instability is one of the strongest predictors of repeat contact with police, EDs, and jails. Housing First (supportive housing with services, without treatment or sobriety prerequisites) is the most consistently studied approach.

The research is unambiguous on housing stability. Housing First reliably increases retention (typically 70 to 90% at 2 to 3 years versus 30 to 50% in treatment-first models) and reduces ED visits and hospitalizations. Its effects on substance use and psychiatric symptoms are smaller and more mixed than many SIM documents imply. Its effects on arrest are real but modest on its own. They get larger when housing is bundled with assertive community treatment, peer support, or medications for opioid use disorder. Economic reviews find that supportive housing can offset a substantial share of its costs through reduced use of crisis, hospital, and justice services.

In Texas, Local Mental Health Authorities and community partners coordinate housing through Medicaid, state programs, and federal supports. The Corporation for Supportive Housing is the national reference for program design and a useful first call. Texas HHS maintains state-level coordination. Counties will not solve the housing shortage on their own, but targeted strategies can make sure people leaving custody or crisis settings have at least one placement option that actually works.

The most common mistake is treating housing as a stand-alone intervention. Placements without services, or placements without follow-up, fall apart fast. Housing alone will not treat substance use or serious mental illness. What it does is make treatment possible.

I0-09 · Expand Front-End Access to Behavioral Health Care

Limited access to routine behavioral health care is one of the biggest drivers of crisis-system involvement. When people cannot get in early, symptoms build until police or the ED become the default front door. The core practices for fixing this are the same in most places: same-day or walk-in intake, extended hours, telehealth, and warm handoffs at the point a person first asks for help.

The evidence on engagement is clear. A 2023 pediatric study found that warm handoffs more than tripled the odds of mental health service engagement. Open-access scheduling consistently reduces no-show rates. Telehealth warm handoffs produce similar engagement gains and reach rural areas in-person models cannot. Where the evidence thins is on the hardest outcomes. Most studies measure attendance in primary-care-integrated settings, not crisis or arrest outcomes.

In Texas, Tropical Texas Behavioral Health and Tri County Behavioral Healthcare are among the LMHAs that have moved toward same-day and walk-in access. Both are useful calls for counties redesigning intake. Nationally, the Certified Community Behavioral Health Clinic (CCBHC) model, covered separately later in this section, provides the clearest funded vehicle for this practice.

Simply opening the door does not help if there is nothing behind it. Front-end redesign that is not matched with back-end capacity moves the wait from phone to waiting room. Workforce shortages can also cap what is possible regardless of how the intake is structured.

I0-11 · Strengthen Post-Crisis Follow-Up and Warm Handoffs

One of the biggest gaps in the behavioral health system is what happens after a crisis resolves. Too often, people leave the ED or the crisis center with a phone number on a piece of paper, and the next contact is another 911 call. The practice here is simple: within 24 to 72 hours of discharge, someone reaches out, and the referral is a warm handoff rather than a passive one.

This is one of the cleanest parts of the evidence base. A 2022 systematic review of six randomized trials covering more than 6,000 participants showed that "caring contacts" (brief supportive letters, texts, or calls after a crisis) reduce suicidal thoughts and attempts by roughly 20 to 40%. A large VA trial of caring letters to Veterans Crisis Line callers found no significant reduction in suicide attempts, though it did increase engagement in mental health care. Warm handoffs at discharge improve first-appointment attendance substantially over passive referrals.

The Zero Suicide initiative maintains a toolkit that is the practical reference for operationalizing this. The strongest programs are concrete and disciplined about the handoff.

The first three days are the highest-risk window for another crisis event. Follow-up that arrives outside that window is worth less. This practice pairs naturally with lethal means safety, covered later in this section. Together they address most of the non-homicide fatal risk for people moving through Intercept 0 and Intercept 1.

I0-12 · Address Transportation as a Core Access Issue

Transportation shows up in just about every SIM conversation as a top barrier to behavioral health care, especially in rural Texas. When people cannot reliably get to an appointment, conditions drift until they re-enter the system through the ED or an officer's car.

The barrier itself is well documented. Urban Institute surveys find that more than one in five adults with limited transit access forgo care because they cannot get to it. During COVID, about a third of people reported missing or delaying behavioral health appointments because of transportation. The relationship runs in both directions. Anxiety and depression themselves make it harder to arrange a ride. What the research has not yet shown is whether specific interventions translate into better health or criminal-justice outcomes. Most studies measure rides given and appointments attended, not what happens downstream.

In Texas, LMHAs coordinate transportation directly, partner with EMS, or contract with providers. Voucher programs, ride-share partnerships, and regional coordination agreements are all in various stages of pilot. The Rural Health Information Hub is a useful cross-state reference for program design.

I0-14 · Invest in Cross-System Training

Training tends to have broader reach when it extends past patrol officers to include dispatch, hospital staff, prosecutors, defense attorneys, EMS, and community providers. Crisis Intervention Team (CIT) training is the best-studied piece of this work, and the broader principle is the same: the encounter goes differently when everyone who touches it understands how to de-escalate, what the local options are, and how to get someone into care.

Across multiple systematic reviews, CIT reliably improves officer knowledge, attitudes toward mental illness, de-escalation confidence, and referrals to services. What the research has not demonstrated, in any randomized trial, is that CIT on its own reduces arrests or use of force. That is the persistent gap in this literature, and it is consistent with a broader pattern: training changes how encounters are handled without necessarily changing who enters the system.

CIT is widely implemented in Houston and San Antonio. The Texas CIT Association, including Shawn Edwards (former Burleson County Sheriff's Deputy and current president), has advanced scenario-based training that emphasizes real-world decision-making and connection to local care. The Association is the most useful Texas starting point for counties building out training programs.

Expecting training alone to change arrest patterns is a common misreading of the evidence. Where there are no options behind the training, the effect on arrest patterns tends to be limited. The knowledge gains are real and useful, and they show up most clearly when paired with a continuum that gives officers somewhere to go.

I0-16 · Use Civil Interventions Strategically and Cautiously

Civil interventions, including Assisted Outpatient Treatment (AOT), are court-ordered outpatient treatment for a narrow group of people with serious mental illness who cycle repeatedly through crisis systems and cannot sustain voluntary care on their own. The practice can be effective for a narrow subset of individuals, and the evidence base counsels caution about how widely it is applied.

The picture in the research is genuinely mixed. A 2025 multisite evaluation found improved treatment adherence for AOT participants (appointments up about 24%, treatment engagement up about 20%). Larger hospitalization effects come from New York's Kendra's Law program, where hospitalization fell from 74% to 36% during AOT, and Swanson and colleagues documented reductions in violent behavior. But the 2025 GAO report concluded that federal assessments of AOT have been inconclusive. Critics, including the Bazelon Center, note that similar outcomes can often be achieved with intensive voluntary assertive community treatment when the infrastructure is actually present. The coercive element is ethically serious, and the literature treats it as a substantive consideration rather than a procedural one.

Texas has expanded AOT access in recent years under Health and Safety Code Chapter 574, but implementation varies widely by county. The most responsible versions are narrowly targeted, well-resourced, and wrapped in voluntary services that make the order more than paper.

Treating AOT as a front-line response is the most common mistake. It works for a narrow population, when paired with services that do not depend on the order to exist.

I0-17 · Create Cross-System Review Teams

Cross-system review teams bring together law enforcement, behavioral health providers, courts, hospitals, and community organizations on a regular cadence to identify system gaps, coordinate responses, and align resources. These teams are the connective tissue of Intercept 0. They are how the pieces stay connected over time.

Mackey and colleagues (2025), in a mixed-methods study of dozens of interagency teams, found that structured collaboration was associated with gains in cross-system knowledge, attitudes toward evidence-based practice, referral mechanisms, and continuity of care. One of the more practical findings is that teams do not appear to need philosophical alignment at the outset. Progress in that study came through operational coordination, which is a much easier bar to clear.

Cross-system review teams are unsuccessful when attendance becomes optional, leadership stops reinforcing participation, and the team drifts.

These six practices were not in the original county SIM reports but have strong 2020 to 2025 evidence bases and fit naturally alongside the practices above. They round out the prevention and front-end access work that Intercept 0 makes possible.

I0-18 · Community-Based Medications for Opioid Use Disorder (MOUD)

Methadone, buprenorphine, and extended-release naltrexone are the medications that treat opioid use disorder. Making them broadly available in the community through LMHAs, Federally Qualified Health Centers, and telehealth is one of the most effective single moves a county can make to address the substance-use driver that fuels most behavioral health crises outside of serious mental illness.

The evidence on MOUD is among the strongest in this space. Santo and colleagues (2021), in a systematic review and meta-analysis, found opioid agonist treatment associated with roughly half the overdose mortality observed out of treatment. Early initiation in EDs and at first law enforcement contact is associated with lower overdose risk across the first one to three months after a crisis, the window when risk runs highest. The intervention is cost-effective, well tolerated, and endorsed across the relevant clinical societies.

Texas LMHAs, FQHCs, and telehealth providers are increasingly the access points for community-based MOUD. The CDC maintains national guidance and Texas-specific overdose response materials. For implementation questions, the American Society of Addiction Medicine (ASAM) is the clinical reference point.

The most common mistake is treating MOUD as a post-release-only practice. The opportunity is biggest at Intercept 0, well before someone is in custody. Provider stigma and prescribing bottlenecks remain real constraints even where the funding exists.

I0-19 · Community Naloxone Distribution and Harm Reduction

Naloxone distribution and related harm-reduction strategies (syringe services, fentanyl test strips, post-release kits) keep people alive long enough to enter treatment. Every overdose prevented at Intercept 0 is an averted crisis contact with EMS, the ED, and often the police.

Community naloxone distribution consistently reduces overdose mortality in population-level studies and meta-analyses. Return-on-investment analyses show substantial savings per dollar invested. The intervention is one of the highest-yield, lowest-cost prevention practices available at this intercept.

The highest-leverage distribution networks combine multiple channels: pharmacies, peer-led organizations, post-release kits from jails, and partnerships with LMHAs and EMS. State health departments in New York, Massachusetts, and Oregon maintain mature public-facing distribution programs that serve as useful models when designing local infrastructure.

Where this practice falters is policy or political hesitation that caps distribution, or programs that operate in isolation from the treatment system. Where distribution is paired with MOUD access, a rescue is more likely to become a pathway into treatment rather than a one-time save.

I0-20 · Certified Community Behavioral Health Clinics (CCBHCs)

CCBHCs are a federally designated clinic model designed to deliver a broad array of behavioral health services with fast access and enhanced funding. In practice, they are a concrete vehicle for the front-end access practice described earlier in this section, with the funding and standards baked in.

Evaluation data on the federal demonstration show faster access (same- or next-week intake), expanded service arrays, and reductions in ED visits and inpatient days relative to pre-CCBHC baselines. Texas participated in the federal demonstration, and the model is gaining ground.

Nationally, the National Council for Mental Wellbeing maintains the CCBHC Success Center, which is the go-to resource for implementation and funding questions. State-level expansion conversations are active. Counties exploring designation have generally found value in engaging early.

The risk to plan for is CCBHC designation arriving without the workforce to back it up. The model depends on the capacity it enables, and where LMHA walk-in capacity is already constrained, workforce investment tends to belong alongside the designation work rather than after it.

I0-21 · Coordinated Specialty Care for Early Psychosis

Coordinated Specialty Care (CSC) is an evidence-based program for young adults experiencing a first episode of psychosis. It combines low-dose antipsychotic medication, supported employment and education, family psychoeducation, and assertive outreach into a single coordinated team.

The RAISE-ETP randomized trial established that CSC improves quality of life and school or work participation over usual care, with the biggest effects for people closest to their first episode. Data from OnTrackNY (the largest U.S. CSC implementation) show substantial drops in hospitalization alongside gains in employment and education. More than 430 CSC programs now operate nationally, partly funded by the 10% federal Mental Health Block Grant set-aside for early psychosis.

OnTrackNY is the most widely referenced model and the best phone call for program-design questions. The approach is a natural fit with Texas LMHAs and is currently underrepresented in the county SIM narratives. The case for adding it is strong.

The constraint to plan for is workforce. The coordinated team model depends on clinicians who can deliver supported employment, family education, and assertive outreach, and that capacity is generally built deliberately rather than assembled from existing roles. Missing the early-episode window is the other risk. Once the first episode is months or years in the past, the effect sizes shrink.

I0-22 · Lethal Means Safety and Means Restriction Counseling

Lethal means safety means reducing access to firearms, medications, and other lethal methods during periods of elevated suicide risk. Often delivered as a structured conversation between a clinician, an officer, or a primary-care provider and the person at risk (or their family). The most common training for this is CALM (Counseling on Access to Lethal Means).

This is one of the most consistently supported suicide-prevention interventions in the public health literature. A 2025 umbrella review and earlier Lancet Psychiatry systematic reviews converge on meaningful population-level mortality reductions when means restriction is paired with other supportive interventions. The intervention is low-cost and can be delivered by a wide range of front-line staff.

CALM training is broadly available for ED clinicians, law enforcement, and primary-care providers. The Suicide Prevention Resource Center maintains the curriculum. In Texas contexts, especially with firearm-owning families, practitioners report better reception when the conversation is framed around temporary voluntary storage during a crisis rather than confiscation.

Two patterns tend to limit the effect: framing the conversation as confiscation, and treating the intervention as belonging only to clinicians. The evidence base extends to law enforcement, primary care, and peer conversations alike. In many Texas communities, the law enforcement voice is the one most likely to be heard.

I0-24 · Family and Caregiver Support

Family and caregiver support means structured programming (education, skills training, support groups, crisis coaching) for the family members and caregivers of people with serious mental illness, especially those at risk of or already involved in the justice system. Families are often the first responders before a 911 call ever happens. Supporting them is a high-leverage Intercept 0 practice.

Family involvement in treatment is consistently associated with improved engagement, lower recidivism, and better long-term recovery outcomes. NAMI's Family-to-Family curriculum and similar programs have a durable evidence base in both peer-reviewed and implementation literature. The intervention is low-cost, peer-delivered, and well-tested.

In Texas, NAMI Texas and its local affiliates run Family-to-Family, Family Support Groups, and Family and Friends programs across the state, many at no cost. They are the most direct implementation partner for counties wanting to add this practice without building something new.

The most common gap is treating families as outside the confidentiality boundary even when they could be meaningfully engaged. The other is reliance on overworked clinicians to deliver family programming that peer-led NAMI models do more effectively.

Y0-01 · Early Intervention and Trauma-Informed Systems

There is a strong and consistent association between adverse childhood experiences and later juvenile justice involvement. Without early detection and intervention, the consequences for children are quite severe. Young trauma survivors may experience cognitive impairment and other health risks. It is very common for youth who did not receive early intervention to exhibit problematic and sometimes criminal activity, including harmful substance misuse.

Many children demonstrate signs of traumatic stress early and throughout their childhood. Preschool aged children might have nightmares or have extreme fear of separation. Elementary school aged children might demonstrate inordinate levels of guilt and shame or have difficulty concentrating. Children might show signs of depression, eating disorders, and drug use.

It is crucial for pediatricians, teachers, counselors, and caregivers to learn to identify and address unresolved trauma in young children before it manifests in problematic behavior and other lifelong consequences. Trauma-informed systems consistently recognize that many young people and families have lived through trauma, whether as a single overwhelming event, such as witnessing or experiencing violence, or as chronic adversity repeated over time. Trauma can involve multiple types of harm, making many youths’ histories complex. At its core, trauma is the combination of exposure to overwhelming or dangerous events and the lasting stress reactions (thoughts, emotions, body responses, and behaviors) that develop as the young person tries to survive and stay safe. These reactions, such as freeze, fight, flight, or shut-down, may protect a child in the moment but can later interfere with learning, relationships, health, and safety if no one helps them understand and adjust them.

A trauma-informed approach focuses on how trauma shapes behavior and relationships, responding in ways that build safety, trust, and hope instead of adding harm. It recognizes that behaviors like “acting out,” shutting down, or using substances may, in some cases, be survival strategies rather than defiance or pathology. The goal is to help youth recognize these reactions, keep what protects them, and replace what harms them with healthier coping and connection. Being trauma-informed also includes attending to the well-being of adults, because hearing about or witnessing trauma can produce secondary traumatic stress. And when youth are involved in multiple systems, such as schools, probation, treatment, and child welfare, coordinating care, reducing repeated questioning, and designing policies and environments that minimize the risk of re-traumatization take on added weight.

As the community develops its strategy, it might consider training from Educational Service Centers and pediatric associations. Parents can also learn to identify and address trauma in a patient and compassionate manner.

Y0-02 · Intensive Care Coordination

Serious mental and emotional disorders among children represent the most complex and costly challenges to Texas communities. The Centers for Medicare and Medicaid Services, in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA), identified the need for Intensive Care Coordination (Wraparound) services for youth and families, especially when their needs exceed what a single agency could provide. They recognized the need for a flexible and individualized approach to serving youth and families with complex challenges. In Texas, wraparound planning is available through the local mental health authority service array and through the Youth Empowerment Services (YES) Waiver.

Y0-03 · Foster Early Mental Health Identification and Intervention

Colizzi, Lasalvia and Ruggeri (2020) note that nearly half of all mental illness starts before age 14, yet early identification and intervention strategies for youth remain limited. Most frequently, the mental health challenges first present themselves as crises at the emergency room, not in schools or in mental health clinics. Where early intervention does not happen, the impact can carry well into adulthood. Often youth with untreated mental health challenges self-medicate with drugs and alcohol, leading to co-occurring mental health and substance use disorders. The gap this points to is early identification strategies that extend beyond emergency rooms and first responders.

While some physicians conduct early and periodic screening, diagnosis, and treatment, these are services covered only by Medicaid. A more robust strategy would involve incentivizing pediatricians and family care physicians to conduct screenings. Through the Child Psychiatry Access Network (CPAN), any pediatrician in the state can be connected with a mental health expert within 5 minutes to do a consultation on a child with concerning psychiatric symptoms. School-based screening can also be effective, making it crucial to involve school districts in communitywide efforts to identify and treat childhood mental illness early.

All these efforts are important, but they may require policy changes, whereas communities can initiate communitywide awareness efforts at any time. Parental education and resource awareness not only helps families know who and when to call for help, they also reduce stigma associated with mental illness.

Y0-04 · Mental Health and Juvenile Justice Interagency Collaboration

Y0-05 · Establish Goals for Youth Crisis Care

Y0-06 · Implement Evidence-Based Youth Mentor Programming

Mentoring programs carry a substantial evidence base for contributing to positive outcomes among youth at higher risk of juvenile justice involvement. Research from the National Institute of Justice and the Office of Juvenile Justice and Delinquency Prevention indicates that mentoring can reduce delinquent behavior, improve academic outcomes, and strengthen a youth’s sense of connection and belonging. When consistent and well supported, mentoring relationships help youth feel that they matter, which is an important protective factor. Some models extend beyond relationship building into advocacy, with mentors making home visits, attending parent teacher conferences, and helping youth meet court requirements and reach community resources. Mentoring has also been linked to improved mental health, especially when youth are paired with trained mentors following release from psychiatric or residential treatment. Programs that are locally developed and those that engage credible messengers with similar lived experience often show stronger engagement and impact.

At the same time, research highlights important cautions. Mentoring can have limited or negative effects when not implemented with quality and consistency. Relationships that end early or mentors who do not follow through can undermine trust and cause harm. Also, in group settings, peer dynamics warrant careful management, since youth may form stronger connections with peers than with mentors, which can reinforce negative behaviors. These risks point to the weight that structure, training, and sustained support carry in this model. Comprehensive training, ongoing supervision, and thoughtful program design are what tend to separate the programs showing positive outcomes from those that do not.

I1-01 · Provide Specialized Crisis Response Training for Law Enforcement

Law enforcement officers are often the first responders to behavioral health crises, and in many places the only ones. Specialized training, particularly Crisis Intervention Team (CIT) training, helps them recognize behavioral health conditions, apply de-escalation, and connect people to services. The training is the foundation that other Intercept 1 practices build on.

Rogers, McNiel and Binder (2019), reviewing the CIT literature, report gains in officer knowledge, attitudes toward mental illness, and confidence in de-escalation, along with increased use of de-escalation in the field. The evidence on arrest reduction is mixed. The larger gains in that literature come from sites where CIT sits alongside accessible diversion options such as a crisis receiving center or a mobile crisis team. Where those alternatives are absent, the measured change in outcomes tends to be small.

CIT is widely implemented in Houston and San Antonio, and the Texas CIT Association is the most useful Texas starting point for counties building or refreshing a training program. Its president, Sgt. Shawn Edwards, works for the Burleson County Sheriff's Office, where he oversees the Crisis Intervention Unit and the Training Division. Burleson County is worth knowing about for small jurisdictions in particular. With a population under 18,000 it hired a full-time mental health deputy in 2020 and received a Texas Association of Counties Best Practices Award for that work in 2022, which is a useful counter to the assumption that this requires a large agency.

CIT delivered in isolation does not move outcomes. It is foundational infrastructure that pays off when the broader continuum exists to use. The most common mistake is counting the training as the intervention itself.

I1-02 · Ensure Officers Understand Their Authority and Discretion to Divert

Officers are more likely to divert people from the criminal justice system when they clearly understand both their legal authority and their department's expectations. In Texas, Code of Criminal Procedure Article 16.23 directs law enforcement agencies to make a good-faith effort to divert individuals experiencing mental health or substance use issues to treatment when certain conditions are met.

Research on police decision-making shows that discretion is a key factor in determining what happens during a behavioral health encounter. When agencies establish clear policies, training, and expectations around diversion, officers are more likely to use alternatives to arrest consistently. When expectations are unclear or unsupported, diversion occurs unevenly even where the legal authority is on the books.

Effective implementation includes training officers on when diversion is appropriate, what options are available, and how to apply discretion safely. Departments that reinforce diversion through policy, supervision, and active partnerships with behavioral health providers demonstrate higher and more consistent diversion rates. The Bureau of Justice Assistance Police-Mental Health Collaboration Toolkit is a useful reference for departments writing or updating their policies.

Impact tends to be greatest where the authority is paired with available treatment options and clear operational protocols. Where diversion authority exists in law but is not supported in day-to-day practice, the effect on outcomes tends to be limited.

I1-03 · Train Officers on Emergency Detention Authority

Emergency detention gives law enforcement a critical tool for responding to severe behavioral health crises without resorting to arrest. In Texas, officers may take individuals into custody without a warrant under Health and Safety Code Chapter 573 when there is a substantial risk of serious harm and insufficient time to obtain a warrant. Used well, this pathway routes people into clinical care rather than booking.

Research on civil detention pathways indicates they can reduce arrests and facilitate access to care when used appropriately. Improper use can lead to unnecessary detention or strain on healthcare systems. Effective outcomes depend on officers understanding legal thresholds, documentation requirements, and appropriate clinical destinations.

Training carries much of the weight here. The distinction officers are asked to draw, between situations that call for emergency intervention and those that can be resolved through less restrictive means, is a difficult one to make in the field. Systems that provide clear protocols and accessible receiving facilities tend to see more appropriate use of emergency detention and fewer unnecessary arrests. The Texas Judicial Commission on Mental Health maintains training resources and model policies that are useful starting points.

Emergency detention tends to work better where it is paired with adequate clinical capacity and clear transport options. Where healthcare systems are overburdened or officers lack clarity on procedures, the intended effect may not materialize.

I1-04 · Designate Specialized Mental Health Officers or Units

Many law enforcement agencies have improved outcomes by designating officers or units with advanced training and experience in behavioral health response. These officers serve as internal subject matter experts, back up patrol officers in real time, and often take the lead on complex or repeat cases.

The Council of State Governments Justice Center (2019), synthesizing police and mental health collaboration models, describes specialized units as improving coordination with behavioral health providers and raising the likelihood of diversion to services. Formal evaluations are limited compared with other interventions. The available studies point toward agencies with dedicated mental health officers using de-escalation more consistently and connecting people to care more often.

In Texas, the Dallas and San Antonio police departments operate dedicated mental health units that work closely with Local Mental Health Authorities and crisis providers. Smaller and rural communities adapt the model by designating a subset of officers with enhanced training and strong relationships with behavioral health partners. Tropical Texas Behavioral Health, the Local Mental Health Authority for Cameron, Hidalgo, and Willacy counties, operates a Mental Health Officer Team whose officers are co-located in TTBH clinics and dispatched with the Mobile Crisis Outreach Team, alongside co-responder partnerships with the Pharr, Mission, Harlingen, and Brownsville police departments. In West Texas, the Tom Green County Sheriff's Office fields a six-officer Mental Health Unit, every member of which holds TCOLE mental health certification, responding to crisis calls 24 hours a day in partnership with the area's MHMR behavioral health authority.

These units tend to perform better where they are woven into patrol operations and hold active partnerships with behavioral health providers. Where a unit sits apart from daily operations or is used only for a narrow subset of calls, its reach is correspondingly narrower.

I1-05 · Implement a Deflection-Oriented Response Framework

Deflection provides officers with a structured alternative to arrest by connecting individuals to services at the point of contact. Unlike informal diversion, deflection operates through clearly defined protocols, partnerships, and eligibility criteria. That structure lets officers take consistent action in similar cases.

The strongest evidence for structured deflection comes from Seattle, where Law Enforcement Assisted Diversion was evaluated against a comparison group. Collins, Lonczak and Clifasefi (2017) found LEAD participants were 60 percent less likely to be arrested in the first six months and 58 percent less likely across the full follow up. Their 2019 companion study, using the same quasi-experimental design with 202 LEAD participants and 114 comparison participants, found 1.4 fewer jail bookings per year, roughly 41 fewer jail days, and 88 percent lower odds of a prison sentence, along with a $2,100 drop in legal system costs while costs for the comparison group rose by $5,961. The National Institute of Justice rates LEAD Promising on arrests and Promising on felony charges. Both ratings rest on that one Seattle study.

Evaluations in other places point the same direction but are built differently, and the difference matters. A four site evaluation in North Carolina led by Duke found that actively engaged participants had 50 percent fewer arrests and citations in the six months after referral, with behavioral health service use rising from 34 percent to 71 percent. Colorado’s statewide pilot evaluation found significantly greater declines in arrests for some referral pathways. Washington’s 2023 legislative report shows sharp drops in jail bed days and 911 calls at the pilot sites. None of those three used a comparison group, and the Washington report states plainly that a full outcome evaluation was not funded. Taken together they represent consistent replication of direction rather than independent proof of effect.

Texas does not yet have widespread LEAD replication, but similar approaches are emerging through partnerships between law enforcement agencies and Local Mental Health Authorities, particularly in jurisdictions focused on pre-arrest diversion. The LEAD National Support Bureau and the NIJ evaluation page are the two most useful external references for counties considering implementation.

Deflection tends to show its strongest results where service capacity is solid and protocols are clear. Where officers lack immediate options or referral pathways are unclear, impact may be compromised.

I1-08 · Dedicated Non-Police Crisis Response (CAHOOTS, STAR, ACS Models)

Dedicated non-police crisis response is a different model from co-response. Here, behavioral health clinicians and peers respond to crisis calls without police, on calls that do not involve weapons or active threats of violence. Eugene, Oregon's CAHOOTS is the longest-running example in the country; Denver's STAR and Albuquerque's Community Safety Department are more recent launches that have drawn substantial attention.

These models have documented meaningful reductions in police use-of-force during behavioral health calls, reduced ED visits, and cost savings compared to sending a police unit. Denver STAR's evaluation found significant reductions in low-level arrests within its service area. CAHOOTS has run continuously for more than three decades and handles roughly 20% of Eugene's public safety calls without officer involvement. This is the fastest-growing area of crisis response evidence nationally.

The Denver STAR team and the CAHOOTS program at White Bird Clinic in Eugene are both open to fielding questions from communities considering the model. In Texas, there is no full replication yet, but several counties are exploring the approach and the LMHA-led crisis response work in Austin is the closest local analog.

The model works when the dispatch call-sorting is clean and when the team has a clinical destination to deliver to. It falters when dispatch defaults back to police for anything uncertain, or when the 988 and 911 systems do not talk to each other.

I1-09 · Performance Measurement and Continuous Quality Improvement

Performance measurement is the practice that lets everything else at this intercept actually improve. Tracking diversion rates, response times, outcomes, and cost lets a community see whether a stabilization center is being used, whether a mobile crisis team is reaching the right calls, and whether CIT-trained officers are using the training. Without the data, it is hard to tell a program that is working from one that exists on paper.

CSG Justice Center frameworks specifically emphasize performance dashboards, diversion rate tracking by intercept, and continuous quality improvement cycles as a cross-cutting element of SIM implementation. The research on program fidelity in this space is consistent. Programs that systematically track their performance and apply continuous quality improvement are better positioned to spot gaps and strengthen outcomes over time.

Bexar County's Familiar Faces initiative and the cross-system review teams covered in Intercept 0 are useful examples of this principle applied locally. At the state level, the Texas HHS behavioral health data portal provides a baseline infrastructure that counties can build on without starting from scratch.

The most common disappointment is a dashboard that nobody looks at. Measurement tends to earn its keep when it is paired with a decision-making process that actually draws on it.

Y1-01 · Co-Responder Approach

In a Co-Responder Team Model, at least one law enforcement officer and one mental health professional jointly respond to situations that likely involve a behavioral health crisis. A co-responder team can de-escalate situations and promote diversion to services. Some communities, such as Douglas County, Colorado, have created youth-specific co-responder teams. Its Youth Community Response Team launched in November 2019, responds in schools and in the community, and is described by the county as a co-responder partnership supported by the Board of County Commissioners, law enforcement, Fire/EMS, and mental health providers. As of the county’s current posting, the program hopes to restore two youth focused teams in 2026 whose primary focus would be service in public, private, and charter schools in Douglas County.

Y1-02 · Develop Comprehensive Delinquency Prevention

Strategies that are aimed at reducing the risk of juvenile referral focus on protective factors that keep youth safe, mentally healthy, and on track in school. It is important to recognize that delinquency arises when youth are exposed to a multitude of risk factors in their families and environments.

A comprehensive strategy focuses on increasing youth academic achievement and positive parental relationships. Additionally, pairing youth with mentors is associated with reduced delinquency. DuBois (2021) and the accumulated mentoring literature link positive role models with meaningfully better youth outcomes, including for youth with significant mental and emotional health issues. There is no single program that can accomplish these goals. A comprehensive prevention strategy involves multiple approaches that are tailored to individual youth. Prevention appears to work best alongside intentional efforts by schools, parents, and police to build resilience, involve youth, and see the best in them.

Y1-03 · Disability Awareness Training for Law Enforcement

The Arc National Center on Criminal Justice & Disability partners with law enforcement across the country to increase awareness and provide learning resources on intellectual and developmental disabilities (IDD). People with IDD often have limitations in intellectual functioning and adaptive behaviors such as social, practical, and conceptual skills. The most common diagnoses include autism, Down syndrome, Fragile X syndrome, and Fetal Alcohol Spectrum Disorder. Not every person with a developmental disability has an intellectual disability.

Often there are no outward signs that an individual has IDD, and the officer might misinterpret behavior that is related to their diagnosis as suspicious. When confronted, people with IDD often react with fear, thus reinforcing officer suspicion. The interaction can then cascade, with the person with IDD running away from the officer, stimming (hand flapping, rocking, spinning, or repetition of words or phrases), not following commands, or not looking at the officer’s face.

Often people with IDD will not understand the officer and, out of fear, pretend to understand or quickly admit to committing a crime. Also, when the person with IDD has been the victim of a crime, their interactions with police cause them increased fear and distress, making them hesitant or unclear in describing what happened to them. For these reasons, specialized law enforcement training on IDD carries real weight.

Y1-04 · First Offender Programs

Texas Family Code § 52.031 authorizes a juvenile board to establish a First Offender Program, which allows law enforcement to address certain law violations without referring the youth to juvenile court. The Judicial Commission on Mental Health’s Texas Juvenile Mental Health and Intellectual and Developmental Disabilities Law Bench Book (Fourth Edition, 2025 to 2027) covers law enforcement’s options at initial contact in its Intercept 1 chapter.

I2-01 · Identify Early and Divert When Appropriate

Booking and initial detention are a critical opportunity to identify behavioral health needs and redirect people before deeper system involvement. Most jails screen, but screening alone does not improve outcomes unless it is tied to clear action.

National research documents the gap. A 2025 Pew Charitable Trusts survey found that while the majority of jails conduct behavioral health screening, far fewer use the results to inform diversion, release decisions, or clinical intervention. Article 16.22 in Texas provides the statutory framework, but implementation varies widely. Systems reporting better outcomes tend to have clear pathways triggered by a positive screen: clinical review, attorney notification, and consideration at magistration.

Bexar County has strengthened this approach by linking booking data with behavioral health systems and prioritizing high-need individuals for coordinated intervention. Similar models elsewhere show that early identification paired with structured response can reduce pretrial detention, improve treatment engagement, and prevent deeper justice involvement.

The practice carries the most weight where screening results are immediately actionable and integrated into decision-making across jail, courts, and defense. Where screening is treated as a compliance requirement rather than a decision-making tool, its effect on outcomes tends to be limited.

I2-02 · Ensure Jail Access to Telepsychiatry and Medications

Access to timely psychiatric care and medication at booking bears directly on stabilization and on early legal decisions. What appears to matter most is speed, continuity of care, and integration with court processes, rather than the availability of services on its own.

Early clinical assessment and medication continuity are associated with less behavioral deterioration, better safety within facilities, and more appropriate release decisions. Telepsychiatry has become a common approach in rural or resource-limited jurisdictions, allowing rapid evaluation and treatment without on-site providers. Access to medications for opioid use disorder (MOUD) carries particular weight. The National Institute on Drug Abuse (2024) reports substantially lower risk of overdose and death after release among people who receive MOUD during incarceration, alongside national data showing that fewer than half of jails offer any form of MOUD and only a small share provide universal access.

In Texas, Washington County's collaboration with Texas A&M Telebehavioral Care is a strong example of how smaller jurisdictions can implement telepsychiatry to improve access and continuity of care. The National Commission on Correctional Health Care and the American Society of Addiction Medicine both maintain standards worth consulting when designing the clinical program.

Results tend to be strongest where clinical services begin quickly, medications continue without interruption when appropriate, and information reaches courts and counsel. Where there are delays, or where services sit apart from legal decision-making, impact may be compromised.

I2-03 · Quickly Appoint an Attorney with Training in Mental Health

Early appointment of defense counsel is one of the most effective mechanisms for reducing unnecessary detention and ensuring that behavioral health needs are identified and addressed promptly. Attorneys play a critical role in bridging the legal and clinical systems at the earliest stage of the case.

The Sixth Amendment Center and Pretrial Justice Institute (2014) associate early access to counsel with shorter jail stays and a greater likelihood of pretrial release. When attorneys are trained in mental health law and local resources, they are better equipped to raise issues related to screening (Article 16.22), advocate for clinical evaluation, and pursue diversion or treatment-based release options. Attorneys also play a key role in identifying competency concerns under Chapter 46B, ensuring that individuals who are unable to understand proceedings are appropriately evaluated and diverted into competency restoration pathways.

In Texas, jurisdictions such as Lubbock County have strengthened this practice by developing defense attorneys with specialized knowledge of mental health law and local service systems. Even in smaller counties, timely appointment combined with targeted training is associated with better outcomes. The Texas Indigent Defense Commission is the statewide resource for these practices.

The practice tends to deliver most where counsel is appointed quickly and has access to clinical information and local resources. Where appointment is delayed, or where attorneys have not had training to identify and act on behavioral health needs, the effect is correspondingly smaller.

I2-04 · Embed or Connect Behavioral Health Staff at Booking

Connecting behavioral health professionals to the booking process strengthens both identification and diversion. Initial screening is important, but clinical involvement is what turns screening into action. Clinical staff can conduct more comprehensive assessments, verify existing service connections, and coordinate with courts and counsel in real time.

Studies of jail-based behavioral health models demonstrate that early clinical assessment improves identification of mental health and substance use needs, supports appropriate housing and medication decisions, and increases opportunities for diversion. This does not require a fully staffed clinical unit. Many counties succeed through structured partnerships with Local Mental Health Authorities, using scheduled on-site coverage, on-call consultation, or telehealth-based assessment.

The Bell County SIM report is often cited here, and it repays careful reading, because it describes a need rather than a model. It recommends establishing a local forensic team with regular forensic team meetings, and it documents a lack of communication between prosecutor, police, and jail, along with screening data that is not always communicated to jail medical personnel. Harris County offers a working Texas example instead. A triage and diversion desk sits inside the Joint Processing Center, staffed around the clock by jail diversion specialists from The Harris Center for Mental Health and IDD, so that behavioral health information reaches decision makers while a person is still in booking. For counties without that infrastructure, the CSG Justice Center publications on jail-based behavioral health services are a useful starting point.

Embedding behavioral health expertise tends to pay off where clinicians are part of decision-making and of communication across systems. Where clinical input arrives late or sits siloed from legal processes, its influence on decisions is limited.

I2-05 · Implement Rapid Diversion Pathways from Jail to Community Care

There is a narrow window after booking when diversion is most viable. Rapid diversion pathways allow eligible individuals to be released quickly and connected to treatment before they become more deeply involved in the justice system.

Research on pretrial detention indicates that unnecessary custody is associated with worse outcomes, including higher re-arrest, and that timely release and diversion can improve engagement with treatment. Timing carries a lot of weight. Delays in decision-making are associated with a lower likelihood of successful diversion. The models reporting the strongest results rely on clear eligibility criteria, defined roles across agencies, and streamlined processes that allow decisions to be made quickly.

Early prosecutor screening, jail-based diversion programs, and coordinated release planning with behavioral health providers are common components. Harris County and Bexar County both provide strong examples of how early identification and cross-system coordination can support rapid diversion at scale. Both are useful calls for counties designing local protocols.

Rapid diversion tends to hold up where treatment capacity is available and coordination across systems is strong. Where processes are unclear, delayed, or handled case by case, the results reported are weaker.

I2-06 · Use Data Matching to Identify and Reconnect Individuals to Care

Many individuals entering jail are already connected to behavioral health systems, but that connection is often lost at booking. Data matching between jail records and provider databases allows communities to quickly identify these individuals and reconnect them to existing care.

Data matching identifies a high-need population. It is not itself an intervention, and the distinction decides whether anything changes. In the Denver Supportive Housing Social Impact Bond initiative, both the treatment and comparison groups were drawn from a single eligibility list built by matching police and jail administrative data. Only the group that went on to receive permanent supportive housing with wraparound services improved, with roughly a third fewer police contacts, 40 percent fewer arrests, and an average of 38 fewer days in jail over three years. The Camden Coalition's care management trial, which also identified its population by data match, was null: 62.3 percent of the intervention group and 61.7 percent of the control group were readmitted within 180 days. The honest framing is that matching tells a community who to reach, and the services attached to it determine the result.

Bexar County's Familiar Faces initiative is a leading example, using shared data across behavioral health, healthcare, and justice systems to identify individuals with repeated system contact and coordinate targeted responses. Similar models across the country rely on data-sharing agreements and coordinated case management to reconnect people to care they were already receiving before booking.

Effective implementation requires clear data governance, limited and purposeful data sharing, and a focus on improving outcomes rather than increasing surveillance. These efforts are less effective when data is collected but not used to inform coordinated action.

I2-07 · Strengthen Coordination Between Courts and Behavioral Health Providers

Intercept 2 is where legal and clinical systems intersect, and outcomes depend heavily on how well those systems communicate and align. Without coordination, individuals with behavioral health needs are more likely to remain in custody simply because information is fragmented or unavailable at key decision points.

Tillman, Wurzburg and Fader-Towe (2019) describe cross-system collaboration, particularly between courts, defense counsel, jails, pretrial services, and behavioral health providers, as raising diversion rates, reducing unnecessary detention, and increasing connection to treatment. Courts that have timely access to clinical information are better positioned to make informed decisions about release, conditions of supervision, and referral to services.

In practice, effective coordination includes structured communication channels, a shared understanding of available resources, and clearly defined referral pathways. This usually takes the form of regular cross-system meetings, designated points of contact, and real-time information sharing during booking and early hearings. Williamson County's felony mental health docket provides a structured forum for bringing clinical insight into early case processing. Harris County applies the same principle further upstream, with a triage and diversion desk inside the Joint Processing Center staffed around the clock by jail diversion specialists from The Harris Center. The Bell County SIM report is valuable as a diagnosis rather than a model, since it recommends establishing a local forensic team and documents a lack of communication between prosecutor, police, and jail.

Coordination tends to hold up where it is institutionalized, built into routine processes rather than resting on individual relationships. Where communication is informal, inconsistent, or delayed, it tends not to survive staff turnover.

I2-08 · Risk-Needs-Responsivity (RNR) Assessment

Risk-Needs-Responsivity (RNR) is the most extensively validated framework in the criminal justice assessment literature. It uses structured tools (LSI-R, ORAS, COMPAS, and others) to match the supervision and intervention intensity to the actual risk and needs of the individual. In a SIM context, RNR assessment is what makes diversion and supervision decisions more precise.

The research base for RNR spans more than three decades and includes dozens of validation studies across different populations and jurisdictions. The core finding is consistent. Matching intensity to risk reduces recidivism; mismatching it (either over-supervising low-risk individuals or under-supervising high-risk ones) makes outcomes worse. The National Institute of Corrections and CSG Justice Center both endorse RNR as the standard for criminal justice assessment.

In Texas, adoption varies by county. Some probation departments have integrated RNR tools; jail-based screening tends to focus on behavioral health without RNR integration. The NIC RNR training materials and the CSG Justice Center's implementation guides are the best starting points for counties adding this to their screening infrastructure.

The practice falters when the tool is treated as a scoring exercise rather than a decision-making framework, or when it is applied without training. Fidelity to the model is important. A misapplied RNR score is worse than none.

I2-09 · Diversion Protocols for People with Intellectual and Developmental Disabilities (I/DD)

Individuals with intellectual and developmental disabilities are disproportionately represented in jails, in part because the same behaviors that lead to contact with law enforcement are often expressions of the disability itself. Specialized screening, diversion pathways, and training for law enforcement, court personnel, and jail staff are all evidence-informed responses.

National best-practice guidance converges on a few points. I/DD-specific screening at intake catches people that general behavioral health screens miss. Specialized diversion pathways that route I/DD-involved individuals to appropriate service systems (often different from mental health systems) produce better outcomes. Training for front-line staff on I/DD recognition and communication reduces escalation and improper detention.

In Texas, the Texas Council for Developmental Disabilities and The Arc of Texas are the two most useful partner organizations for counties looking to build out I/DD-specific protocols. The Pathways to Justice Partnership at the Arc maintains a national framework for community-level implementation that has been used successfully in multiple states.

The most common gap is folding I/DD into general behavioral health screening without distinguishing it. The service systems are different, the legal considerations are different, and the diversion pathways are different. Where I/DD is treated as a subset of mental illness, the resulting plan tends not to match what people actually need.

Y2-01 · Collaboration Between Local Schools and Juvenile Detention

Y2-02 · Ensure Presumption of Release

Most of these conditions can be resolved when the child’s mental and behavioral health challenges can be addressed quickly, and the child can be safely returned home to their family or caregiver. As described previously, a comprehensive strategy does not look solely at finding an alternative placement but also addresses the comprehensive needs that keep youth at risk when returned to home following release from detention.

For instance, juvenile probation could work collaboratively with a local mental health authority or other community service provider to mobilize wraparound case management for the child and family. A county might utilize short term respite centers for youth. Alternatively, they might pair family members with a certified family partner who has similar lived experience. They might also engage inpatient or therapeutic group homes. When the focus is on bolstering protective factors for the child or family, releasing the child from detention can also decrease the likelihood of future juvenile involvement.

I3-01 · Transfer to Civil Court via CCP 16.22(c)(5)

Texas Code of Criminal Procedure Article 16.22(c)(5) gives courts a mechanism to redirect individuals with mental illness from the criminal system into civil court for court-ordered outpatient treatment. When a clinical interview suggests likely incompetency, the court may release the person on bail and transfer to civil proceedings under Health and Safety Code Chapter 574, as long as the offense does not involve serious bodily injury.

Traditional competency restoration is slow and resource-intensive, contributing to long detention. Civil court transfer offers a faster, treatment-oriented alternative that avoids progressing deeper into the criminal system. By focusing on stabilization rather than adjudication, this approach reduces jail stays and accelerates access to care.

The Texas Judicial Commission on Mental Health has strengthened implementation through its 16.22 Guide and Court Liaison Pilot Program, which provide structured processes and coordination support. These two resources are the most useful starting points for any court considering this pathway.

The pathway sits unused in many counties even where the law authorizes it. The fix is usually procedural and educational rather than statutory.

I3-02 · Right-Size Competency Restoration Services

Competency restoration systems are under significant strain nationwide. Many individuals wait months in jail for inpatient placement, and those delays contribute to prolonged detention, worsening clinical conditions, and increased system costs.

The available studies describe many individuals as restorable safely and effectively in less restrictive settings, including outpatient and jail-based programs, though the strength of that literature is uneven. Right-sizing competency restoration means developing a full continuum of care (outpatient, jail-based, and inpatient) and matching individuals to the least restrictive appropriate setting based on clinical need and risk.

Texas has advanced this approach through the Eliminate the Wait initiative, which focuses on improving triage, expanding outpatient restoration capacity, and reducing bottlenecks. The strongest Texas evidence is Graziani and colleagues (2015), an evaluation of outpatient competency restoration conducted for the Hogg Foundation for Mental Health and the Department of State Health Services, covering 644 participants across the Austin, Bexar, Dallas, and Tarrant programs, with predicted probabilities of successful restoration ranging from about 65 percent in Bexar and Tarrant to 88 percent in Austin and 91 percent in Dallas. Two limits belong alongside those numbers. No controlled study has shown that outpatient restoration reduces jail time or recidivism, and Candilis and Parker (2024), assessing the competency restoration literature, rated 54 of 76 studies as only fair quality. Colorado is a useful structural reference for how a continuum is organized, operating both outpatient restoration and jail-based evaluation and restoration through its Office of Civil and Forensic Mental Health.

The key driver of success is not simply expanding inpatient capacity but improving placement decisions. Systems that lean heavily on inpatient beds without strong triage tend to keep their backlogs even after expansion.

I3-03 · Prevent Unnecessary Competency Referrals

Over-referral to competency restoration is a major driver of system strain, contributing to long waitlists, prolonged detention, and delayed case resolution. Fader-Towe and Kelly (2020) describe a significant share of individuals referred for competency evaluation as candidates for diversion, treatment, or alternative case resolution instead.

Effective systems equip judges, prosecutors, and defense attorneys to distinguish true incompetency from factors such as substance use, acute crisis, intellectual disability, or situational instability. Early clinical input, particularly at Intercept 2, plays a critical role in improving referral accuracy and reducing unnecessary evaluations. National studies highlight that unnecessary referrals not only burden restoration systems but also delay access for individuals who genuinely require restoration services.

Communities that implement training, clinical consultation, and structured decision-making tools see more appropriate use of competency evaluations and improved system flow. The National Judicial Task Force on Mental Illness and the Courts and the American Academy of Psychiatry and the Law both maintain useful evaluation standards that distinguish competency concerns from other clinical presentations.

The practice depends heavily on what sits beside it: strong diversion options and early clinical assessment. Where competency becomes the default response to behavioral health-related challenges in court, referral volume tends to stay high regardless.

I3-04 · Establish Mental Health Specialty Courts or Dockets

Mental health courts and mental health dockets serve similar populations but differ in structure, scale, and resource requirements, and that distinction matters. A mental health court is a formal program authorized under Texas Government Code Section 125.001, with dedicated staffing, defined eligibility criteria, and structured supervision. A mental health docket is a more flexible approach within an existing court, allowing judges to adapt case management practices for individuals with behavioral health needs without building a full program.

The evidence on mental health courts is positive but narrower than it is usually described. A 2021 meta-analysis by Fox and colleagues, pooling 38 effect sizes from 30 evaluations, found that participation corresponded to a 74 percent decrease in recidivism (OR = 0.26). A 2018 meta-analysis by Lowder, Rade, and Desmarais found a smaller overall effect (d = -.20) and two findings worth carrying forward: effects were weakest on arrest and conviction outcomes and strongest on charge and jail-day outcomes, and larger effects appeared in lower-quality studies than in moderate- and high-quality ones. Outcomes vary substantially with implementation quality and with the treatment capacity actually available to the court.

For many counties, especially smaller jurisdictions, a mental health docket is the more feasible and scalable starting point. Williamson County and Collin County both demonstrate how structured implementation can improve coordination and outcomes, and both are useful reference contacts for Texas counties looking at implementation.

These models tend to underdeliver where treatment capacity is limited, eligibility criteria are narrow, or supervision requirements outrun the available supports. The most common pattern is a docket or court that becomes a deeper level of supervision rather than a genuine diversion.

I3-05 · Implement Rapid Case Review and Early Diversion Processes

Rapid case review processes bring together judges, prosecutors, defense attorneys, and behavioral health partners within the first days or weeks after arrest to determine appropriate case pathways before individuals become entrenched in the system. These processes are distinct from mental health courts or dockets. Rather than providing ongoing supervision, rapid case review focuses on early decision-making, including dismissal, diversion, transfer to civil processes, or placement into treatment-oriented programs.

Research on caseflow management and early intervention indicates that front-end case review can reduce unnecessary detention, shorten case processing time, and improve access to treatment. The models reporting the best results rely on structured, predictable processes with clearly defined roles and timelines. Regularly scheduled review dockets or staffing meetings are how most of them keep cases moving consistently.

Rapid case review is particularly valuable in jurisdictions without the capacity to operate full specialty courts. It offers a scalable approach to improving early case outcomes and can be a precursor to a full mental health docket as capacity grows.

Structure is what separates the stronger models: predictable processes, defined roles, and set timelines. Informal or ad hoc coordination tends to produce uneven outcomes and missed opportunities for diversion.

I3-06 · Use Data to Manage Case Flow and Reduce Length of Stay

Length of stay for individuals with behavioral health needs is often driven by system inefficiencies rather than public safety concerns. Delays in competency evaluation, restoration placement, and case processing contribute to unnecessary detention and increased system costs.

Research on caseflow management shows that courts that track and actively manage key metrics achieve shorter case processing times and improved outcomes. Relevant measures include time to competency evaluation, time to restoration placement, and overall length of stay for individuals with behavioral health needs. Courts that regularly review this data can identify bottlenecks, allocate resources more effectively, and improve accountability.

The Texas Office of Court Administration is the statewide infrastructure that supports judicial data work. The National Center for State Courts maintains the most comprehensive caseflow management resources for courts considering this practice.

The value of this practice tracks closely with whether the data actually reaches decision-making and system improvement. Where data is collected but not regularly reviewed or acted on, the effort tends not to change outcomes.

I3-07 · Strengthen Judicial Leadership and Cross-System Coordination

Judicial leadership is one of the most influential drivers of system performance at Intercept 3. Effective leadership extends beyond presiding over individual cases. It involves actively convening system partners, establishing structured coordination processes, and setting clear expectations for timely communication and decision-making.

Research on court-led system reform shows that jurisdictions with engaged judicial leadership demonstrate improved case processing times, stronger interagency collaboration, and more consistent use of diversion and treatment options. Judges who are trained in behavioral health and system dynamics are better positioned to apply tools such as diversion pathways, competency processes, and treatment-based resolutions in a coordinated and timely way.

In practice, this leadership often takes the form of regular cross-system staffing meetings, early case review processes, and clearly defined communication channels between courts, prosecutors, defense counsel, jails, and behavioral health providers. Bell County's structured collaboration model illustrates how judicial leadership can align these partners to support faster, more coordinated decision-making.

Judicial leadership tends to carry furthest where it is consistent, visible, and supported by data and shared accountability. Where coordination rests on informal relationships or varies by courtroom, it is harder to sustain across turnover.

I3-10 · Co-Occurring Disorder Specialty Dockets

Mental health courts are well-established. Substance use treatment courts (drug courts) are even better established. The newer development is dockets that specifically integrate treatment for co-occurring mental health and substance use disorders, since most justice-involved individuals with behavioral health needs have both.

Integrated treatment approaches in COD-specific dockets have demonstrated better outcomes than single-disorder courts. The research base draws on the broader evidence for integrated dual-diagnosis treatment, which is among the most consistently supported approaches in behavioral health, applied through a court-supervised structure. The National Treatment Court Resource Center, formerly the National Drug Court Resource Center, and SAMHSA's Center of Excellence for Integrated Health Solutions both maintain implementation materials.

In Texas, several counties operate hybrid mental health and drug court structures, but few have built explicitly COD-focused dockets. The opportunity is meaningful given that the population already appears in both court types. The Texas Judicial Commission on Mental Health and the Texas Association of Specialty Courts are the useful in-state contacts. The latter began in 1998 as the Texas Association of Drug Court Professionals and now operates under the broader name, so older references to TADCP point to the same organization.

The most common pitfall is a hybrid docket in name that runs parallel treatment in practice. Integrated treatment depends on clinical infrastructure that not every community has, and the docket tends to perform no better than the clinical model behind it.

Y3-01 · Family Engagement in Juvenile Court

Family engagement in the juvenile court process bears directly on outcomes for youth. Families are among the strongest influences on positive behavior and skill building, and positive family engagement is associated with better mental health outcomes, school achievement, and peer relationships.

Most communities struggle to engage families effectively. It is not uncommon for courts and probation staff to become more directive, considering ways to require families to remain involved, which makes partnering with the family to create optimal outcomes a challenge. Sometimes courts have no clear way of promoting family engagement throughout the process.

Additionally, courts and juvenile probation offices might consider creating more formal partnerships with families of justice-involved youth. For instance, the Juvenile Probation Department of Pierce County, Washington, established a family council to help the department shift toward a family-centered approach. The Department of Youth Services in Massachusetts offers family therapy among its clinical services and individualizes what each family receives through the DYS Clinical Assessment of Needs, rather than relying on a single program or class that may or may not address a given family’s needs. The Department also hired a Director of Family Engagement to work with families and ensure the system partners with families as the experts. Montana developed a family mentoring program, pairing parents with family partners.

In Williamson County, Texas, the Juvenile Probation Department excels at parent and family engagement. In support of their goals, they have recruited community members and businesses to provide treats, experiences, and accessible events for families whose children are involved in the juvenile justice system.

These are just a few examples of successful approaches to family engagement.

Y3-02 · Streamlined Fitness Restoration Process

The Legal Education Attainment Program (LEAP), developed by Harris County Juvenile Probation, provides a community-based restoration option for youth who do not need inpatient hospitalization. Materials presented at the Judicial Commission on Mental Health’s Judicial Summit on Mental Health list nine participating programs, one of which is the State of Utah. The program reports outcomes similar to hospital-based restoration and provides a much-needed alternative to using scarce hospital beds. The Judicial Commission on Mental Health’s Texas Juvenile Mental Health and Intellectual and Developmental Disabilities Law Bench Book (Fourth Edition, 2025 to 2027) provides more details about LEAP.

Y3-03 · Trauma-Informed Juvenile Court Systems

According to the National Child Traumatic Stress Network, more than 80 percent of juvenile justice-involved youth report having experienced trauma with many of them having experienced multiple, chronic, and pervasive personal trauma. That prevalence is what drives the case for trauma training and trauma-informed practice among juvenile courts and the organizations serving justice-involved youth.

I4-01 · Provide Comprehensive Reentry Planning

Reentry planning is one of the most critical and most frequently underdeveloped points in the system. Without coordinated planning, people lose access to medications, housing, benefits, and care almost immediately after release.

The Vera Institute of Justice documents sharply elevated risk of overdose and death in the days and weeks following release, particularly for opioid use disorder. Reentry planning is the mechanism most often credited with reducing that risk, through continuity of care, access to medications, and connection to community-based services. What distinguishes the stronger programs is that the planning goes well beyond discharge paperwork.

In Texas, emerging models incorporate Certified Reentry Peer Support Specialists to help individuals navigate this transition and maintain engagement. The CSG Justice Center reentry resources and the BJA Second Chance Act program both maintain useful implementation materials.

Even when reentry planning is done well, structural barriers (housing shortages, transportation challenges, workforce limitations) can undermine outcomes. Without planning, however, those challenges become significantly more likely to result in crisis, relapse, or re-arrest.

I4-02 · Integrate Peer Support for Justice-Involved Individuals

Peer support is one of the most effective engagement strategies for justice-involved individuals, particularly during reentry. Individuals with lived experience are uniquely positioned to build trust, support recovery, and help navigate complex systems.

The peer support literature associates the model with better engagement in treatment, reduced substance use, and stronger retention in services. Evidence specific to justice settings is still developing. For justice-involved populations, peers are especially valuable during transitions, helping individuals navigate housing, benefits, treatment systems, and supervision requirements.

In Texas, Certified Reentry Peer Support Specialists are increasingly integrated into jail and community-based programs, providing support both prior to release and during reentry. In practice, peers may meet individuals in jail, develop reentry plans, and continue working with them in the community to maintain engagement. The Texas HHS peer services portal and SAMHSA peer support toolkit are useful starting points for counties building this capacity.

Peer support tends to do more where it is integrated into broader care systems and backed by training and supervision. Where it operates as a stand-alone service without coordination with treatment providers and case managers, its reach is narrower.

I4-03 · Expand Access to Recovery and Supportive Housing Through Reentry Planning

Housing is among the strongest predictors of reentry success. For people leaving jail with mental illness or substance use disorders, the absence of stable housing is associated with a substantially higher likelihood of relapse, crisis, and re-arrest.

Fontaine (2013) and the supportive housing literature that follows it associate supportive and recovery housing with greater stability, higher treatment engagement, and less criminal justice involvement. Recovery housing carries particular weight for people with substance use disorders, providing structure and peer support during early recovery. The reentry systems reporting the best housing outcomes do not treat housing as a separate track. They connect people to housing resources before release.

In Texas, Local Mental Health Authorities and community partners play a key role in coordinating housing access, though availability remains limited in many areas. Reentry planners and peer specialists often serve as the bridge between individuals and housing providers, helping navigate eligibility and placement. The Corporation for Supportive Housing and the National Alliance for Recovery Residences are useful national references.

Housing strategies tend to hold up where they are paired with services such as case management, treatment, and peer support. Where housing is provided without ongoing support, or where people are released without a clear housing plan, the gains tend not to last.

I4-04 · Ensure Continuity of Medications and Benefits at Release

Continuity of medications and benefits at release is among the most immediate factors shaping reentry outcomes. Interruptions in psychiatric medications or medications for opioid use disorder (MOUD) are associated with elevated risk of relapse, hospitalization, overdose, and re-arrest, frequently within days of release. Vera Institute of Justice (2020) documents how concentrated overdose deaths are in the period immediately after release.

Cates and Brown (2023), reviewing medications for opioid use disorder during incarceration and post-release outcomes, report lower post-release mortality and stronger engagement in care where medication is continued. Access to Medicaid or other benefits is likewise associated with greater use of outpatient services and less reliance on emergency systems. Where enrollment is not active or reactivated before release, people commonly leave custody without a practical way to access care or afford medications.

The foundational federal reference is CMS State Medicaid Director Letter #23-003, issued April 17, 2023, which invited states to test reentry transition strategies under a Section 1115 demonstration. Texas has not pursued that demonstration, so the operative Texas lever is the county jail reporting process. When a county jail reports that a person has been confined for more than 30 days, HHSC suspends Medicaid coverage rather than ending it, and reinstates coverage within two business days of the jail reporting the release, provided the original certification period has not ended. Texas Local Government Code Sections 351.046 and 351.047 set out the sheriff's notification role and allow a county to contract for help reinstating benefits. Separately, and effective January 1, 2026, federal law prohibits states from terminating Medicaid or CHIP enrollment solely because a person is incarcerated.

Impact tends to be greatest where continuity is built into the discharge process and coordinated with community providers. Where people are released holding a prescription but without a practical way to fill it, or with an incomplete benefits application, the intended effect may not materialize.

I4-05 · Establish Warm Handoff Protocols to Community Providers

The transition from custody to community care is one of the most fragile points in the system. Without a direct connection to services, engagement in care is often low even when referrals are provided.

The Agency for Healthcare Research and Quality (2017) describes the warm handoff, where responsibility for care is actively transferred to a specific provider, as improving treatment engagement and continuity. This includes scheduling appointments prior to release, confirming provider acceptance, and ensuring that individuals have a clear point of contact at the receiving end.

Effective models often involve peer specialists or case managers who meet individuals prior to release and continue engagement in the community. Some programs include direct transportation from jail to treatment providers or in-person introductions at the first appointment. The CSG Justice Center reentry materials cover the operational details for both approaches.

Warm handoffs tend to work best where they are specific, immediate, and relationship-based. Where referrals are passive, delayed, or unaccompanied by follow-up, the handoff tends not to hold.

I4-06 · Strengthen Cross-Agency Collaboration for Reentry

Reentry outcomes depend on coordination across multiple systems, including corrections, behavioral health providers, housing agencies, supervision, and community-based organizations. Without structured collaboration, individuals often fall through gaps between systems.

The reentry coordination literature associates interagency coordination with better service access, less duplication of effort, and more successful reintegration. Programs supported through the Justice and Mental Health Collaboration Program (JMHCP) point toward formal partnerships, backed by clear roles, shared protocols, and information-sharing agreements, outperforming isolated efforts.

Collaboration that works tends to include regular communication, shared planning processes, and defined responsibility for reentry coordination. Information sharing within legal and privacy constraints is a recurring prerequisite for continuity of care. The National Reentry Resource Center and the Urban Institute reentry research collection are useful national references.

The approach tends to hold up where collaboration is formalized and carried by leadership. Where coordination rests on informal relationships or varies across agencies, it tends to erode as people move on.

I4-07 · Use Community Health Workers and Reentry Navigators

Community health workers and reentry navigators provide practical, hands-on support that helps individuals successfully transition from custody to community. These roles focus on addressing real-world barriers such as accessing services, attending appointments, securing identification, and navigating benefits systems.

The strongest single piece of evidence here is a randomized trial of the Transitions Clinic model in San Francisco, and it supports a narrower claim than it is often given. Wang and colleagues found that participants had lower emergency department use than the comparison group (25.5 percent versus 39.2 percent, P = .04) but similar primary care use (37.7 percent versus 47.1 percent, P = .18), with 37.7 percent being the intervention arm. The comparison group received expedited primary care rather than no care, which makes this a demanding test. NIJ's CrimeSolutions profiles the same trial under the name Primary Care-Based Complex Care Management (San Francisco, Calif.) and rates it Ineffective, because the emergency department reduction was not accompanied by gains in primary care use or reductions in recidivism. The defensible claim is that navigators reduce avoidable emergency department use. A separate observational study across the Transitions Clinic Network describes how community health workers with lived incarceration experience carry out that engagement work, though its design cannot establish effect.

In practice, navigators often work alongside peer specialists or case managers, providing logistical and systems-level support. They may assist with transportation, accompany individuals to appointments, and help coordinate across providers. The CDC community health worker resources and the BJA Second Chance Act materials are useful starting points for counties building this capacity.

These roles tend to contribute most where they are integrated into reentry planning and connected to broader service systems. Where they sit apart from care coordination, or without a clear scope and support structure, their impact is harder to detect.

I4-08 · Pre-Release Medicaid Enrollment and Benefits Restoration

Pre-release Medicaid enrollment is a specific, measurable practice that improves treatment access on day one of release. The federal opening for it is CMS State Medicaid Director Letter #23-003, issued April 17, 2023, which invited states to test reentry services under a Section 1115 demonstration. As of July 29, 2026, CMS lists 18 states with approved reentry demonstrations. Texas is not among them.

The evidence base is straightforward. People released with active Medicaid coverage are far more likely to fill their first prescription, attend their first appointment, and maintain engagement during the highest-risk first 30 days. Without active coverage, the same individuals often cannot access the care that was planned for them. The intervention is operational rather than clinical: it requires changes to enrollment processes, not new services.

Approved states have used that flexibility to authorize Medicaid coverage for a limited set of services up to 90 days before release. Because Texas has not pursued a reentry demonstration, Texas counties work within existing state policy, where the practical lever is the county jail reporting process: HHSC suspends rather than ends coverage for a person confined more than 30 days, and reinstates it within two business days of the jail reporting the release. The CSG Justice Center has published the most useful implementation materials for counties looking to advance pre-release enrollment within current state policy.

The most common shortfall is paperwork completed too late. Coverage that activates two weeks after release misses the highest-risk window.

I4-09 · Employment and Vocational Training (Including Individual Placement and Support)

Employment is consistently identified in national research as a key predictor of reentry success and reduced recidivism. For individuals with serious mental illness, the strongest evidence-based model is Individual Placement and Support (IPS), which integrates employment services into the behavioral health treatment team.

IPS has more than two decades of randomized controlled trial evidence showing better employment outcomes than traditional vocational rehabilitation, including for justice-involved populations. Other evidence-based reentry employment models include transitional employment programs and vocational training during incarceration. SAMHSA and the Department of Labor both endorse employment support as integral to behavioral health recovery.

In Texas, the Texas Workforce Commission administers vocational rehabilitation. The program transferred from the Department of Assistive and Rehabilitative Services to TWC effective September 1, 2016 under Senate Bill 208 of the 84th Legislature, and TWC has since run it as a single integrated program. HHSC is the partner for long-term services and supports, not the administrator of vocational rehabilitation, and that distinction matters when a county is deciding whom to call. Several LMHAs operate IPS programs. The IPS Employment Center maintains the national fidelity standards and is the authoritative reference for program design.

The most common shortfall is vocational services offered in isolation from clinical care, or employment treated as a final-stage outcome rather than a driver of recovery. IPS inverts that assumption, and the evidence base behind it is unusually strong.

Y4-01 · Start Reentry Planning Upon Juvenile Referral

According to the Justice Center of the Council on State Governments, the most effective reentry planning occurs when the planning begins at intake and continues through family reintegration and aftercare. The outcomes described depend on case management that begins with the end in mind: resilient children bolstered by protective factors within their families and communities. In practice that means juvenile probation departments working with case managers in the community to identify the risk factors bearing on successful reentry. A flexible and individualized approach is most likely to achieve success.

Y4-02 · School Transition

Justice-involved youth are at high risk of falling behind their peers, forcing them to repeat grades and increasing the likelihood they drop out of school entirely. State law (Texas Education Code § 37.023) requires that all returning students have a transition plan, but many districts are either unaware of these obligations or they lack the training and guidance to do transition planning effectively. As an additional support, the Texas Legislature passed H.B. 5195 in 2023, which added section 54.021 to the Texas Family Code. That section is narrower than it first appears. It applies only to a child ordered detained under section 54.02(h), meaning a youth whose case has been transferred to adult criminal court. For those youth, the detention facility must, by the 21st day of detention, assess the child and develop a written plan to reach rehabilitation goals, and must provide a status report every 90 days.

I5-01 · Align Supervision Intensity with Stability and Need

Supervision tends to produce better outcomes where it supports stability rather than adding to the likelihood of failure. For individuals with mental illness or co-occurring disorders, standard probation conditions can become unmanageable quickly. What looks like noncompliance is often the result of symptoms, transportation barriers, housing instability, or competing survival needs.

The Council of State Governments Justice Center (2019), in Confined and Costly, documents the volume of technical violations driving incarceration without a corresponding public safety return. Models that align supervision intensity with risk and need, particularly for people with behavioral health conditions, are associated with better outcomes, including fewer revocations and stronger engagement.

North Carolina's Specialty Mental Health Probation program illustrates how smaller caseloads and treatment-focused supervision are being applied at scale. HOPE-informed models emphasize fewer, clearer conditions and proportionate responses, with the aim of reducing unnecessary incarceration for technical violations. Both are useful national reference programs. HOPE-style swift-certain models are a cautionary case: the original Hawaii results did not replicate, and the four-site HOPE Demonstration Field Experiment found no advantage over standard probation, with the federal CrimeSolutions registry rating HOPE Ineffective. The durable evidence supports aligning supervision intensity to risk and need and pairing proportionate responses with incentives, rather than swift-certain sanctions alone.

Where supervision is not aligned with behavioral health needs, it can function as a pathway back to jail rather than a meaningful alternative. The most common pattern is a standard supervision template applied to every client regardless of stability or clinical need.

I5-02 · Broaden Measures of Success to Include Stability, Health, and Community Integration

Definitions of success in supervision that rest solely on compliance or the absence of re-arrest leave out much of what matters. For individuals with mental illness, meaningful outcomes include stable housing, medication continuity, treatment engagement, connection to benefits, and supportive community relationships. These are not alternatives to public safety. They are its foundation.

The reentry and supervision outcomes literature describes traditional measures such as revocation and re-arrest as capturing little of the progress toward long-term stability. Systems that incorporate broader indicators (housing status, healthcare engagement, reduced crisis system utilization) are better positioned to intervene early and support sustained success.

Initiatives such as Reentry 2030 are advancing this approach by encouraging states to track outcomes related to employment, housing, and health alongside public safety metrics. The National Reentry Resource Center and NIJ's reentry outcomes work are useful national references for counties defining their own measures.

The systems getting the most from these measures use them to guide supervision decisions, recognize progress, and respond early when instability emerges, not only to report. Where the measures sit in a quarterly report nobody reads, they tend not to change anything.

I5-03 · Use Trauma-Informed and Problem-Solving Supervision Approaches

A large proportion of individuals under supervision have experienced trauma. When triggered, they may perceive authority as a threat and respond with fear, avoidance, or disengagement. That response pattern makes traditional supervision approaches less effective and increases the likelihood of violation.

The trauma-informed supervision literature associates these approaches with better engagement, less conflict, and stronger officer-client relationships. Problem-solving supervision builds on this by focusing on identifying and addressing underlying barriers rather than responding punitively to symptoms. In practice, this means shifting responses to behavior. When an individual misses appointments, the officer assesses underlying barriers such as housing instability or transportation, and focuses on re-engagement. A failed drug test prompts increased treatment support rather than automatic escalation.

A number of states have begun incorporating trauma-informed and problem-solving approaches into supervision practices, with a focus on reducing revocations and improving outcomes. In Texas, probation departments are increasingly integrating these principles through partnerships with Local Mental Health Authorities.

These approaches maintain accountability while prioritizing strategies that increase stability. They tend to take hold where training, supervision, and organizational culture support them. Where they are applied inconsistently or without structural support, the shift tends not to stick.

I5-04 · Establish Revocation Prevention Pathways

Revocation is a major driver of incarceration for individuals on community supervision. For those with mental illness or co-occurring disorders, violations are often linked to instability, symptoms, or structural barriers, not intentional noncompliance.

The Council of State Governments Justice Center (2019) documents technical violations as a significant share of revocations, and the accompanying literature finds little public safety return from punitive responses to them. The systems reporting better results establish structured response pathways that intervene early and prioritize stabilization.

In practice, this means defining clear response sequences before revocation is considered. A missed appointment triggers assessment of underlying causes such as housing loss, medication disruption, or relapse, and a stabilization response: reconnecting to treatment, involving a peer specialist, or adjusting supervision expectations. Some jurisdictions formalize this through multidisciplinary staffing and graduated response matrices. Georgia and North Carolina have implemented structured response models that emphasize swift, certain, and proportionate responses combined with treatment-oriented interventions.

Revocation prevention does not remove accountability. It describes a structured process that reserves revocation for persistent risk after multiple intervention attempts.

I5-05 · Create Specialized Behavioral Health Supervision Caseloads

Individuals with mental illness benefit from supervision models specifically designed to support stability and engagement. Specialized behavioral health caseloads use smaller officer-to-client ratios, targeted training, and a problem-solving approach rather than a surveillance model.

Skeem and Eno Louden (2006), and the specialty probation literature that followed, associate specialized caseloads with better engagement in treatment where the model is implemented with fidelity. Key features include reduced caseload sizes (typically 30 to 50 individuals per officer versus 130 or more on general caseloads), training in mental health and substance use, and close coordination with treatment providers. One attribution is worth stating precisely, because it is frequently overstated. NIJ's CrimeSolutions rated Specialty Mental Health Probation (Texas) as Promising on November 7, 2022, on the strength of more than one study. That is a rating of one Texas program, not a rating of specialized caseloads as a general practice.

North Carolina has taken the model furthest. As of June 2026 the state reported specialty mental health probation in all 100 counties, with roughly 255 specialty officers supervising about 1,800 people and caseloads capped near 40 rather than the 60 or more a standard officer carries. The outcome evidence is mixed. A randomized trial by Van Deinse and colleagues found a higher rate of mental health engagement on specialty caseloads, and also found that more individuals on specialty caseloads had a new crime violation during follow-up than individuals on standard caseloads. In Texas, several probation departments have developed mental health caseloads in partnership with Local Mental Health Authorities.

These models tend to deliver where caseload sizes are meaningfully reduced and officers have training and access to treatment resources. Where a caseload is labeled "specialized" but carries standard sizes or limited clinical coordination, the distinction tends to be nominal.

I5-06 · Strengthen Coordination Between Supervision and Behavioral Health Systems

Individuals under supervision often navigate multiple systems simultaneously. Without coordination, they may receive conflicting expectations, miss services, or disengage from care. That sequence leads to avoidable violations and deeper system involvement.

The coordination literature associates aligned supervision and treatment with better engagement, fewer violations, and stronger long-term stability. The systems that sustain it align supervision with behavioral health care through structured partnerships between probation departments and Local Mental Health Authorities.

In practice, this includes joint case staffing, shared communication protocols, and clearly defined roles. When early signs of instability appear, such as missed appointments or medication lapses, officers and clinicians respond together: confirming the issue, reconnecting the individual to care, and adjusting supervision expectations as needed. Some jurisdictions formalize this through cross-agency teams similar to mental health court staffing models.

The approach tends to hold where coordination is structured, consistent, and carried by leadership. Where communication is informal or rests on individual relationships, it seldom survives staff turnover.

I5-07 · Align Supervision Conditions with Behavioral Health Reality

Supervision conditions are often written as if individuals have stable housing, transportation, income, and consistent access to care. For many people with mental illness or co-occurring disorders, those conditions do not exist. Where expectations do not match reality, supervision can amount to a setup for failure.

Research on community supervision consistently shows that overly complex or unrealistic conditions increase technical violations without improving public safety. Effective systems instead align conditions with what individuals can reasonably achieve given their clinical needs and available services.

In practice, this means prioritizing a small number of achievable expectations, such as treatment engagement and safety, and adjusting conditions when barriers arise. If someone is on a treatment waitlist, the response is not a violation but continued engagement through case management or peer support. Some jurisdictions simplify or sequence conditions to avoid overwhelming individuals with competing demands.

The approach depends on officers having flexibility and support to adjust conditions in real time. Where conditions are fixed, numerous, or disconnected from available services, that flexibility is not there to use.

I5-08 · Incorporate Peer Support into Community Supervision

Peer support brings something supervision alone cannot: trust. For individuals with mental illness, especially those who have had negative experiences with systems, peer specialists can engage where traditional supervision often cannot.

Peer support has been associated with better engagement in services, stronger retention in treatment, and reduced substance use. In the context of supervision, peers help individuals navigate expectations, overcome practical barriers, and reconnect after periods of disengagement.

Effective systems integrate peer support at key moments: initial engagement, after violations, and during periods of instability. In Texas, Certified Reentry Peer Support Specialists are increasingly deployed through partnerships with Local Mental Health Authorities and community organizations. In practice, peers may re-engage individuals who have missed appointments, identify barriers such as transportation or anxiety, and help translate supervision requirements into manageable steps.

Peer support tends to contribute most where it is integrated into supervision processes and coordinated with officers and providers. Where it runs as a stand-alone service without connection to supervision or care systems, its effect is harder to see.

I5-09 · Graduated Sanctions and Incentive-Based Supervision

Graduated sanctions and positive incentives are a structured way of responding to supervision violations and successes. The principle is simple. Responses are designed to be swift, certain, and proportionate to the behavior, with compliance recognized as explicitly as violations are.

The incentives half of this practice is well supported. Guidance distributed through the National Institute of Corrections library states plainly that positive reinforcement is more effective than sanctions for long-term behavior change, with four positives to each negative as the suggested ratio, and programs that track and reward small steps see better outcomes than programs that only track violations. The sanctions half is weaker than it is usually presented. The HOPE demonstration field experiment found that swift, certain, and fair supervision was not associated with significant reductions in arrests compared with probation as usual, apart from a reduction in drug-related arrests at one site, and a 2024 meta-analysis reported an overall effect of -.058 and concluded that the evidence is not robust enough to support continued government funding of these programs in their current form. The defensible position is to build the framework around proportionate responses and explicit incentives rather than around the swift-certain-fair label.

Several states have formalized this approach through structured response matrices that spell out expected responses to common violations and common achievements. Georgia's accountability courts work and North Carolina's Specialty Mental Health Probation both incorporate these principles.

The most common gap is a matrix that lists sanctions in detail but leaves incentives out entirely. Positive reinforcement is not a soft option, and it is the better supported half of the model in this literature.

I5-10 · Record Clearance and Expungement

Criminal records create lasting barriers in housing, employment, education, and professional licensing. For people with behavioral health needs who are trying to rebuild stability, the record itself becomes a structural driver of re-involvement. Connecting individuals with expungement legal clinics is a low-cost community support intervention with a supporting evidence base.

Prescott and Starr (2020), in an empirical study of Michigan expungement recipients, report substantial gains in employment and wages following record clearance, alongside low rates of subsequent offending among recipients. The intervention is essentially legal service delivery, but its impact falls squarely in behavioral health and reentry outcomes.

In Texas, expungement options are narrower than in many states, but the practice is still meaningful for the cases that qualify. The Texas Fair Defense Project, Texas RioGrande Legal Aid, and the Lone Star Legal Aid expungement programs are useful referral partners. Many law school clinics in Texas also run periodic expungement events that are worth coordinating with.

How to make record clearance part of the SIM strategy:

The practice has clear limits. Texas law restricts expungement to a narrow set of circumstances, and much of what clients hope for is not actually available. Setting expectations realistically is part of the practice.

This guide is meant as a reference, not a sequence. Counties and communities are at different places in their SIM work, and the right starting point depends on what is already in place, what the gaps are, and what the most pressing local problem is.

Y5-01 · Develop a Community Approach to Juvenile Probation

Many of the practices already covered in this report, including wraparound case management, family engagement, and reentry planning, bear on probation outcomes as well. In a rural area with limited resources, juvenile probation departments may lack the internal resources and community services that might be available in larger cities. That gap puts a premium on courts and probation departments in smaller counties rethinking how probation can partner with local mental health authorities, schools, CRCGs, and other community resources. Juvenile probation does not have to be in it alone.

For instance, where probation partners with schools so that youth with mental health, learning, or developmental disorders receive the appropriate educational supports, educational outcomes tend to improve. As an example, Disability Rights Texas reported in 2021 that it partners with the Harris County Juvenile Probation Department through an education advocacy program, taking probation officer referrals to advocate for special education services and accommodations.

Juvenile probation departments in smaller areas might also consider using certified peers with relevant lived experience to work alongside youth with mental and emotional health challenges and certified family partners to work with families. Departments could also recruit mentors and other volunteers to assist with positive youth development.

Juvenile probation departments might also consider partnering with a workforce development board or other vocational resources to establish training and job preparation programs for youth on probation. The Annie E. Casey Foundation provides a number of examples across the country of successful workforce/probation partnerships.

There are just a few examples of partnerships that can help smaller counties achieve optimal juvenile probation outcomes.

Y5-02 · Family Engagement in Juvenile Services and Probation

Y5-03 · Certified Family Partners Supporting Families of Juvenile Justice-Involved Youth

Family engagement is widely identified in the juvenile justice literature as an important contributor to positive youth outcomes, though the Office of Juvenile Justice and Delinquency Prevention cautions that the available research does not isolate the independent impact of family engagement itself. Qualitative research with families and the professionals who serve them describes shame, confusion, and mistrust as recurring experiences when navigating courts, probation, mental health services, and schools. These experiences can reduce family participation in programs, such as juvenile probation, that depend on parental involvement.

Certified Family Partners (CFPs), who combine professional training with their lived experience raising a child with behavioral health challenges, are uniquely positioned to address these barriers. Their training, expertise in navigating complex juvenile justice and mental health systems, and commitment to trauma-informed approaches equip them to provide emotional support and build confidence. Their direct support to families helps grow caregiver self-efficacy, their internal sense that they can succeed as a parent. All of these are the key conditions for improving family participation.

Preliminary studies indicate that CFPs may contribute directly to outcomes associated with reduced recidivism, improvements in child engagement with juvenile and mental health programming, and overall improved family functioning. For instance, a parent-to-parent program in King County, Washington demonstrated positive effects for parents involved in the juvenile dependency system. In a controlled study of a peer partner program, parents showed a measurable increase in parental self-efficacy. Parents in that study also rated peer partners more highly than court staff on the process of care, and described reduced feelings of isolation and blame in their open-ended responses.

Certified Family Partners can reinforce the core principles of evidence-based family interventions such as multi-systemic therapy (MST) by helping parents build motivation, navigate services, follow through on plans, and advocate effectively for their children. Overall, there are good reasons to think that incorporating Certified Family Partners into juvenile justice will measurably improve outcomes for both youth and their caregivers.