Introducing the Simple (Sequential Intercept Model Practices, Leadership, and Expertise) Scorecard

Background: Individuals with serious mental illness (SMI) are overrepresented in the criminal/legal system. At jail booking, people with SMI are often under-identified, lack connections to jail-based treatment (Kubiak, Comartin, Hanna, & Swanson, 2020), stay longer in jail (Comartin, Nelson, Smith, & Kubiak, 2021; Council of State Governments, 2012), and face a higher risk of recidivism (Matejowski, Conrad & Ostermann, 2017). The overrepresentation of people with SMI spurred the Sequential Intercept Model (SIM) framework to target interventions across the criminal/legal continuum to divert people with SMI into treatment (Munetz & Griffin, 2006). Currently, no research combines and connects interventions across the SIM to county-level outcomes (Epperson et al., 2014). This exploratory study aims to define and operationalize Sequential Intercept Model Practices, Leadership, and Expertise factors into a ‘SIMPLE’ scorecard that could direct strategic planning to deflect and divert individuals with behavioral health needs from the criminal/legal system.

Methods: Counties can earn a possible 36 SIMPLE points for practices and policies such as: law enforcement referrals to the mental health system, evidence-based jail screening tools for SMI, specialty courts, discharge planning as a standard reentry practice, and more. We assessed outcomes of: prevalence of mental illness in jails (using the Kessler-6), jail-based mental health services, length of stay in jail, and recidivism. Our assertions are: (1) counties vary in SIMPLE scores, (2) the higher SIMPLE score, the better the outcomes, and (3) counties that improve SIMPLE scores will show improved outcomes over time. Our primary independent variables include: a sum SIMPLE score (all categories summed), a pre-booking score (sum of intercepts 0 and 1) and post-booking score (sum of intercepts 2-5). SIMPLE scores were created for 15 unique counties, and for 23 separate data collections (8 counties had 2 data collections).

Results: Using the sample of 23 data collection periods, a set of 3 OLS regressions was run for each of the 4 dependent variables. SIMPLE sum score (B=1.439, p<.05) and SIMPLE post-booking score (B=3.360, p<.001) were significant predictors for jail-based mental health services, wherein higher scores led to increased access to services. Next, researchers created change scores for the 8 counties that had repeated data collections (in 2017 & 2019). Researchers ran Pearson’s Bivariate Correlations. Change in SIMPLE pre-booking scores was trending significant (p=0.062) and negatively associated with mental health prevalence change scores.

Conclusions: The trending negative relationship between pre-booking SIMPLE score and jail SMI prevalence over a two-year period could be promising. Counties that made multiple improvements at pre-booking intercepts 0 and 1 reduced their respective SMI booking prevalences over two years; those who made isolated or no pre-booking changes showed increased SMI bookings. Our change score findings are correlational and limited in power, though they support broader, system-level partnerships beyond law enforcement training (Usher et al., 2019). In measuring connections to jail-based treatment across counties, the positive correlation with post-booking and overall SIMPLE scores is encouraging. Public mental health systems could use the SIMPLE scorecard as a strategic planning tool to drive behavioral health and justice system change.