A police department in northern Delaware developed a co-responder program called the Behavioural Health Unit (BHU) that deployed a trained police officer and mental health clinician to assist individuals presenting with serious mental health issues. The study described in the source article examined diversion/deflection outcomes and estimated the cost savings of decisions to divert people with mental illness (PWMI) from incarceration and hospital emergency care. Between 2020 and 2023, the BHU handled a growing average number of dispatches and increased the average number of connections to care via referrals. Importantly, the program led to fewer instances of incarceration (n = 120) and emergency room visits (n = 97). Both types of diversions yielded a cost savings of over $2.8 million.

Objective:To determine the prevalence and determinants of beliefs in substance use deflection programs' effectiveness among police officers working in agencies with diversion initiatives. Methods:We present responses from an anonymous online survey about deflection programs fielded to all law enforcement officers in the State of Delaware in January 2025. A total of 111 officers reported working in an agency with a substance use deflection program and completed relevant survey questions. Descriptive statistics summarize police officers' views on program effectiveness, attitudes toward leadership, beliefs in enforcing the law, occupational experiences, and personal characteristics. Logistic regression models isolate the factors associated with beliefs in program effectiveness. Descriptive statistics identify common barriers to deflection program implementation. Results:A majority (59%) believe their programs are effective. On average, over three-quarters of respondents express that deflection programs are appropriate, feasible, and implementable. Tough-on-crime attitudes and being in a position for less than five years diminish the likelihood of stating that a deflection program is effective. Knowing someone who has a substance use or mental health disorder and working in a larger police department increases perceptions of program effectiveness. The three most commonly cited barriers to program implementation were having people interested in treatment, homelessness/housing issues, and the potential ineffectiveness of diversion. Conclusions:Police officers generally believe their departments' substance use deflection programs are successful. Even more officers think programs can be easily and appropriately implemented. Commonly cited barriers highlight the difficulties in addressing substance use in communities. Policy Implications:This overall support for deflection underscores the potential for further cross-system collaborations with public health practitioners. Such partnerships may also be vital in addressing barriers that inhibit law enforcement-based deflection efforts. Further evaluation and research efforts can demonstrate the impacts of substance use deflection and the practices that make deflection programs more successful.

To better serve people with mental illness (PWMI), law enforcement agencies have considered programmatic alternatives to arrest, transport, or informal guidance. The police-clinician, co-responder model represents one such approach that promises cost-saving deflections. This study examines a co-responder program led by specially trained police officers and mental health professionals embedded in the New Castle County Division of Police (NCCPD). It evaluates program impacts and cost savings from diversions from hospitalization and formal criminal processing. Results show that NCCPD's Behavioral Health Unit contributed to a growing average number of confirmed connections to care per quarter. Diversions from the emergency room (n = 97) and incarceration (n = 120) contributed to cost savings of $2.8 million since the program's inception, or over a quarter million dollars per quarter. Findings highlight the ability of co-responder models to successfully divert PWMI out of health and justice systems while diminishing associated costs.

PurposeThis study explores the determinants of police officer support for pre-arrest/booking deflection programs that divert people presenting with substance use and/or mental health disorder symptoms out of the criminal justice system and connect them to supportive services.Design/methodology/approachThis study analyzes responses from 254 surveys fielded to police officers in Delaware. Questionnaires asked about views on leadership, approaches toward crime, training, occupational experience and officer’s personal characteristics. The study applies a new machine learning method called kernel-based regularized least squares (KRLS) for non-linearities and interactions among independent variables. Estimates from a KRLS model are compared with those from an ordinary least square regression (OLS) model.FindingsSupport for diversion is positively associated with leadership endorsing diversion and thinking of new ways to solve problems. Tough-on-crime attitudes diminish programmatic support. Tenure becomes less predictive of police attitudes in the KRLS model, suggesting interactions with other factors. The KRLS model explains a larger proportion of the variance in officer attitudes than the traditional OLS model.Originality/valueThe study demonstrates the usefulness of the KRLS method for practitioners and scholars seeking to illuminate patterns in police attitudes. It further underscores the importance of agency leadership in legitimizing deflection as a pathway to addressing behavioral health challenges in communities.

Prisons are stressful environments for both people living and working in them. Extant literature suggests that correctional staff have increased stress levels that lead to compromised physical health, mental health, social relationships, and increased emotional strain. This article reports on a project utilizing a modified Participatory Action Research (PAR) approach to understand the mechanisms that lead to increased stress levels among correctional officers who reported working overtime. The analysis utilizes organizational justice and social comparison frameworks to explore predictors of individual levels of stress among correctional officers working overtime in a Delaware prison. The findings indicate that individual-level stress spreads through perceptions of coworker’s stress and is inversely related to perceived levels of organizational justice. This analysis is useful to prison administrators, leadership, in suggesting avenues to improve the climate of correctional environments.

This project sought to understand the present-day experiences of individuals housed in prisons by utilizing Participatory Action Research (PAR) methods that partnered a university research team with individuals incarcerated in an urban correctional facility. The team assessed perceptions of the current environment by surveying people incarcerated in an urban prison. This article discusses the role of PAR methodologies from project initiation to finalization, explicitly focusing on coordination with prison and Department of Correction (DOC) administrative leadership and the value of including incarcerated individuals on the research team for successful change. Throughout the process, the team identified areas for improvement and innovations to improve the prison environment. This article provides a road map, lessons learned from conducting PAR in prison environments, and the power of partnering researchers and members of the researched population on one collaborative research team.

Recent upticks of stimulant presence in overdose deaths suggest the opioid epidemic is morphing, which raises questions about what drugs are involved and who is impacted. We investigate annual and growth rate trends in combined opioid-stimulant overdose toxicology between 2013 and 2019 for White, Black, and Hispanic male and female decedents in Delaware. During these years, toxicology shifted to illegal drugs for all with fentanyl leading the increase and opioid-cocaine combinations rising substantially. While combined opioid-cocaine toxicology grew among Black and Hispanic Delawareans, White males continue to report the highest rates overall. These findings depart from historical patterns and may challenge existing opioid epidemic policies.

To reduce opioid-involved overdoses, law enforcement agencies have taken proactive steps to connect people to treatment and supportive services. This study evaluates the impact of a law enforcement-based outreach and treatment referral program known as Hero Help on the incidence and costs of overdoses occurring in the jurisdiction of Delaware's New Castle County Division of Police (NCCPD). It first compares observed and predicted fatal and nonfatal overdoses between 2013 and 2021. A time series analysis shows an average decrease of 7.25 nonfatal and 1.85 fatal overdoses per month since the program's two expansions of its civilian care team. It then adapts Centers for Disease Control and Prevention and health care cost data to estimate the cost reductions of fewer overdoses. These metrics suggest Hero Help saved the community $21.5 million per month. Police departments can then reduce the incidence and economic burden of overdoses through outreach and referrals to treatment.

Purpose – This chapter discusses the utility of engaging in participatory action research (PAR) methodologies to investigate prison climates within correctional settings. In doing so, facilitators and barriers accompanying this research approach are highlighted.Methodology/Approach – PAR methodologies were adopted to investigate living and working conditions within a Mid-Atlantic prison. In line with this approach, members of the incarcerated population and staff within the institution were selected to be members of the research team.Findings – Following the PAR framework to studying prison climates, several barriers and facilitators in conducting this research were identified and are presented to inform continued efforts investigating prison conditions and culture.Originality/Value – Overall, a limited understanding of prison conditions, culture, and quality of life within correctional institutions exists. Moreover, a lack of attention has been devoted to improving working and living conditions behind the prison walls. Therefore, efforts to improve the prison environment are limited due to a lack of data about prison conditions and quality of life within these settings. PAR methodologies provide an important framework for addressing these gaps.

The journey to drug crime literature has found that, in cities, Black people travel shorter distances from their homes before being arrested relative to White people. Per race and rationality theory, the racialization of space shapes the decision-making processes of people arrested for drug offenses. Because residential segregation patterns and racialized social structures differ across levels of urbanization, this study uses negative binomial regression models to evaluate Black-White differences in journeys to crime for drug possessions, and the study assesses socioeconomic and opportunity characteristics of offense locations at the micro-level using drug arrest reports across the State of Delaware. We find that travel distances and predictors of offense locations differ across geographic areas (i.e., small cities, suburban areas, small towns, rural areas, and touristic rural areas). A place’s racial composition, concentrated disadvantage, and opportunity characteristics differently impact offense locations across geographic areas. Accordingly, in studying journeys to crime, researchers should consider the various ways that race shapes constructions of crime and place across the rural–urban continuum.

Late-blooming offending is a young but fast-growing area in offending trajectory research. Since the formulation of this theory by Thornberry and Krohn, few empirical tests using US offender samples have been conducted. Based on 30 years of criminal history data, this study uses group-based trajectory modeling to empirically test the existence of a late-blooming trajectory among a sample of US offenders. We also compare family structural disadvantages and temperament traits across distinct groups of offenders. The analyses yield empirical support for the theoretical propositions by Thornberry and Krohn. A late bloomer offender group was identified by the model results, which took up about 20% of the sample. Findings suggest that late bloomers have similar temperament difficulties as life-course-persistent offenders. However, their family environments are more nurturing, which may explain why their heavy engagement in offending does not emerge until adulthood. The findings from this study extend our understanding of the heterogeneous etiologies and trajectories of offending over the life course.

As opioid addiction has risen in recent years, racial disparities in drug arrests may be changing in their size and sources. Neighborhood conditions, like economic disadvantage and racial composition, are powerful determinants of racial differences in arrests. Overdoses and police responses to these incidents may, however, alter the neighborhood context of drug arrests, especially those tied to heroin, synthetic narcotics, and related opium derivatives offenses. This study revisits the environmental correlates of arrest disparities by conducting a neighborhood-level analysis of Black–White differences in drug possession and selling arrests by substance type across the State of Delaware. Spatial model estimates suggest economic disadvantage and racial diversity in neighborhoods substantially increase Black arrest rates. Conversely, White arrest rates grow with more calls for service for overdose incidents, racial homogeneity, and to a lesser extent, economic disadvantage within a community. Disparities in arrest also vary by substance type, as heroin arrests for Whites are most correlated with higher overdose service calls relative to White arrests for marijuana, cocaine, and other substances or Black arrests for any substance. Results underscore the need to reexamine neighborhood conditions and arrest disparities due to emerging shifts in drug use and drug law enforcement.

Studies show that residents from urban, high-risk neighborhoods fair worse on multiple behavioral and health outcomes than their counterparts from more socially and economically advantaged neighborhoods. However, few research efforts have been devoted to examining how formerly incarcerated individuals' concerns over neighborhood environment are associated with reentry outcomes. Using longitudinal data that captured the reentry experiences of individuals released from prison, the present study quantifies how returning citizens' concerns over neighborhood environment predict their social withdrawal and mental health deterioration. Findings suggest that when respondents' post-release family bonds, financial difficulty, drug use, and past mental health histories are all taken into account, their concerns over neighborhood environment exert a significant and positive effect on social withdrawal, depression, and hostility. Returning citizens who believe it is hard to stay out of trouble and prison in their neighborhoods tend to avoid social interactions with others and experience depression and increased hostility and vigilance. Implications for reentry programing and interventions are discussed.

Increases in opioid-related overdoses have required law enforcement and public health officials to collectively develop new approaches that treat substance use disorders and save lives. This essay describes the Hero Help recovery and behavioural health assistance program, a Delaware-based initiative providing drug treatment to qualifying adults who contact the police and ask for treatment, or to individuals in lieu of an arrest or upon recommendation by a police officer. Led by the New Castle County Division of Police, this collaborative project has brought together stakeholders from public health and criminal justice to coordinate treatment for people suffering from a substance use disorder and/or mental health problems. This essay describes the goals, evolution, and key activities of the program. It further highlights lessons learned, including improving credibility through concerted community outreach, finding ways to overcome the stigma associated with participating in a law enforcement–based program, gaining officer buy-in, and using data to inform treatment responses. Effectively, this essay seeks to disseminate emerging lessons in creating programming responsive to substance use disorder and mental illness among police departments and their community partners.

Justice-involved individuals struggle with a multitude of health issues, and addressing the needs of these individuals requires the efforts of multiple agencies working across traditionally siloed systems. This study provides evidence on the implementation of a one-stop health services delivery model, Culture of Health, piloted in an urban probation office. This model uses a change team approach to focus the efforts of multiple agencies toward improving the alignment, collaboration, and synergy of health and other social service delivery to this underserved population. This article reports on the development and application issues involved in instituting such a novel design. The study demonstrates that the health culture within probation, buy-in from probation officers, and dwindling support from change team members all posed noteworthy issues for program implementation.

The majority of reentry studies focus on identifying different dimensions of reentry needs among released prisoners. Less explored is the mechanism by which unfulfilled reentry needs cause reentry failure. Applying the general strain theoretical perspective, this study aims to use an emotional and psychological prism to explain why released prisoners are likely to experience reentry failure when their reentry needs are not met. Findings demonstrate that the strains from financial difficulty and family neglect are positively associated with post-release criminal propensity, and depression noticeably mediated the effects of strains. Implications for correctional policymaking and future research are discussed.

Journeys to crime, or distances traveled from residences to places of alleged crimes, describe how people enter into the criminal justice system. Race, as an ascribed characteristic of individuals and a determinant of community conditions, introduces disparities in journeys to crime. Use of opioids among nonurban, White populations and changing law enforcement responses prompt inquiry into how race affects journeys to crime associated with opioid possession. This study evaluates Black–White differences in travel among persons arrested for opioid possession in Delaware. It applies race and rationality theory to assess the effects of race and racialized context on travel patterns. Multilevel models reveal travel to possess opioids is greater for White relative to Black Delawareans. Community conditions such as marijuana possession arrest rates and concentrated disadvantage have varying impacts on travel from various geographic areas. Racial–spatial differences in travel show persistent disparities in drug law enforcement amid efforts to curb opioid misuse.

Opioid abuse has redefined drug problems in communities and shifted police activities to redress substance use. Changing neighborhood context around opioid issues may affect arrests and racial disparities in their imposition. This study presents a spatial analysis of arrests involving Blacks and Whites for possession of heroin, synthetic narcotics, and opium offenses. We identify the ecological conditions associated with opioid-related arrests using geographically weighted regression (GWR) methods that illuminate local patterns by allowing coefficients to vary across space. GWR models reveal spatial and racial differences in opioid-related possession arrest rates. Calls for police service for overdoses increase White arrests in more advantaged, rural communities. Economic disadvantage and racial diversity in neighborhoods more strongly elevate possession arrest rates among Blacks relative to Whites. Overdose calls predict Black arrests in poorer urban areas. Findings underscore police responsiveness to opioid problems and Black–White differences in how opioid users interact with the criminal justice system.

Increases in opioid overdose deaths have been pronounced throughout the nation. The current narrative about them stresses their reach into middle‐class America while theories that link substance use etiology and drug markets, such as availability‐proneness theory, suggest that lower‐income communities should be most impacted. The latter might be especially true due to the increased involvement of cheap and highly potent fentanyl. This study uses group‐based multi‐trajectory models and path analysis to assess relations among neighborhood opioid‐overdose death trends, drug type compositions, and socioeconomic neighborhood characteristics across Delaware from 2013 to 2017. We find support for availability‐proneness theory, insofar as drug availability and substance use are associated with neighborhoods in the trajectory groups with the highest overdose death rates. Moreover, we find that neighborhood disadvantage is associated with increased drug availability as well as substance use. Our results also suggest that open‐air drug market access might be associated with an increased risk of fentanyl and heroin exposure which, in turn, can lead to spikes in overdoses net of other risk factors. Overall, our findings reveal the social character of the opioid epidemic and inform the literature on social inequality and drug use. We highlight the need for community reinvestment and harm reduction strategies to alleviate the drug problems in the most disadvantaged communities.

Background:The US opioid epidemic largely featured deaths from prescribed medications during Wave 1 (1990-2010), but its progression since then has resulted more so from deaths to illegal opioids-such as heroin (Wave 2 - 2010-2013) and fentanyl (Wave 3 - 2013-present). As deaths to illegally manufactured fentanyl have increased, attention to the role of prescribed opioids may be waning. However, the shifting nature of today's opioid epidemic demands we monitor how both legal and illegal drugs are involved in overdose deaths.Objectives:The purpose of our study is to investigate the prescription drug (Rx) records of overdose death decedents to illuminate the continued role of prescribed medications in Wave 3 deaths.Methods:We matched drug overdose death data and prescription drug monitoring data to investigate the prescription drug records (i.e. types of opioids and other medications) of Delaware, USA, decedents who died from a drug overdose death between January 1, 2013, and March 31, 2015 (27 months).Results: Fentanyl decedents differed significantly from other decedents in prescribed medications, including the amount and proximity of opioid and Rx fentanyl prescriptions before death. These relationships held while controlling for demographic characteristics and contributing health conditions.Conclusions: Our findings show a continued presence of Rx opioids in overdose deaths and that those dying from fentanyl had different Rx records than those who died from other drugs. Continued monitoring of Rx drugs, improved toxicology testing and greater data access for more research should follow to inform effective interventions.