a courtroom with a judge overseeing a case

Some criminal offenders with drug and other charges may have an option that allows them to participate in a problem-solving court program—a pretrial diversionary program that treats the underlying problems that contribute to criminal behavior and improves outcomes for victims, litigants and communities. Although the mission of problem-solving courts is fairly uniform, the strategies they use to keep drug misusers alive and healthy vary tremendously.

Elizabeth Van Nostrand, a legal epidemiologist and associate professor in the College of Public Health’s Department of Health Services Administration and Policy, is currently leading a study that seeks to understand which interventions work best for drug offenders of different ages and backgrounds. “It’s similar to precision medicine,” she says. “We are trying to determine which policies are effective for specific subpopulations. We believe that this will not only help individuals arrested for drug misuse, but also result in cost savings for courts and communities.”

Van Nostrand arrived at CPH in the summer of 2021 from the University of Pittsburgh and brought with her a $1.8 million R01 CDC grant to complete the study. Now in its fourth and final year, this study is first-ever to dissect such policies and interventions in an effort to discover which strategies are most effective for different groups.

The study targets interventions given to problem-solving court participants in Indiana from January 2018 to June 2021. “We chose Indiana for this study because it is unique. Indiana has a huge governmentally supported data warehouse directed by the Management Performance Hub (MPH) that already has linked individually identifiable information on drug related arrests, EMS calls, emergency department presentation, re-arrests and death data. It also contains information from the Prescription Drug Monitoring Program that allows us to see whether an individual was prescribed a medication like suboxone as part of their therapy.”

A qualitative team at the University of Pittsburgh has conducted dozens of interviews with personnel from problem solving courts and correctional facilities to identify interventions. The data from the interviews are transcribed and coded and will be linked with the datasets housed at MPH. Next, a team of biostatistician will perform analyses to tease out which specific interventions impact health outcomes for specific populations. A modeling team will take the identified impactful interventions and integrate them in a large-scale agent-based model. The model will show the effect that introducing the impactful intervention would have in counties in Indiana.

“The variances between what types of interventions are provided by problem-solving courts will enable us to see what works for different subpopulations by age, gender, race and ethnicity. At the end of the day, we’ll be able to take these findings, disseminate them across the nation, and share what interventions will work best for which people,” Van Nostrand says.

Because the COVID pandemic struck in the middle of this study, Van Nostrand and her team will also look at what changed during COVID, when interventions such as group therapy may have moved to Zoom—excluding offenders who may not have a functional device or internet access—to understand what happened when such interventions were upended or interrupted.

“The ultimate goal of this project is to save lives. If we are able to help courts and correctional facilities target what works and keeps people alive and healthy, we will have fulfilled the mission of this project.”

Formal collaborators include the Indiana Department of Health and Indiana’s Management Performance Hub. Van Nostrand says she expects to have recommendations and best practices ready to share by the end of 2023.