Case Study: Allegheny County, Pa.
Integrating Justice and Human Services Data
The Allegheny County data warehouse was created in the early 2000s by consolidating publicly funded human services data, including behavioral health, child welfare, intellectual disability, homelessness and aging. Since then, it has expanded to include 21 categories of data. Whereas the county owns much of the data that goes into the warehouse, some information is shared from external sources such as school districts, public benefits and the Pennsylvania Department of Labor and Industry. The data warehouse is part of the county’s commitment to building a data-driven system that improves service delivery, decision-making and communication with the public. The county’s data warehouse is a critical resource in its efforts to improve public safety through the Allegheny County Jail Collaborative (ACJC). Formed in 2000, the ACJC represents a group of county government agencies, not-for-profit organizations and other stakeholders from the community that meet monthly to identify and implement innovative approaches to preventing people from returning to jail. Developing and implementing a comprehensive plan to divert, treat and support people with behavioral health conditions is one of the ACJC’s strategies for reducing recidivism.
The data warehouse is managed by the county’s Department of Human Services (DHS). DHS provides a range of services that include but are not limited to mental health treatment, substance use and alcohol treatment and emergency shelter. Many of DHS’s services are delivered through a network of contracted service providers. The data warehouse includes protected health information (PHI) and other information subject to privacy laws and ethical practices. DHS is one of several departments within Allegheny County government that must comply with the privacy and confidentiality requirements of the Health Insurance Portability and Accountability Act (HIPAA). Because it pays for services and wants to ensure the quality, coordination and continuity of those services, DHS is considered a “covered component” within the county umbrella. DHS approaches information sharing as an essential component of its provision of care. As a payor and an oversight entity, it can require its contracted providers to share relevant client information.
Behavioral health service providers are permitted by HIPAA and state law to share without consent for purposes of treatment and related payment and operational activities. Similar to DHS, these providers are required to comply with HIPAA regulations that they provide a notice of privacy practices to their clients. This notice outlines how their information may be shared and for what purposes. Not all DHS services are strictly governed by these rules, but as a best practice, and in instances when the law requires it, the county encourages obtaining informed consent from clients whenever possible. DHS providers typically obtain releases that permit the sharing of client information with DHS and for facilitating client care.
Formal agreements or memoranda of understanding were not required for data sharing between county programs (e.g., sharing between DHS and the county health department or medical examiner), because all county departments fall under the supervision of the county executive and thus are part of the same organizational and reporting structure. With the county executive having ultimate oversight and authority to enter into agreements, it did not make practical sense for departments to enter into agreements when the executive would authorize the agreement for both sides. In addition to maintaining quarterly audit procedures, annual trainings and routine monitoring of the technology’s security, the county is continuously looking at ways to improve on procedures that promote good data stewardship.
Using Data to Analyze Services and Outcomes
Analytic tools have been developed to support use of the integrated data. Some of these tools are publicly available while others are available only to authorized users, including providers and DHS staff.
One of the publicly available tools is called “QuickCount.” This tool aggregates client data and allows for queries about participation in a wide range of services, including comparisons of the number of people who participate in more than one service. Users can limit the count to a period of time and can break down populations by sex, age, race, state legislative district, county council district, school district and zip code. For example, the public can use the tool to understand the cross-system involvement of people booked in the jail who also received publicly-funded mental health services. Specifically, using the filters, users could find that of all people booked in the jail in 2017, 68 percent previously received publicly funded mental health services. Three-quarters of women booked in the jail received mental health services compared to 67 percent of men. Several data dashboards and visualizations are also publicly available at the Allegheny County Analytics website (www.alleghenycountyanalytics.us).
“Client View,” a tool that is accessible only with authorization and log-in credentials, provides information about individual DHS clients and their service involvement, including across multiple DHS program offices. Accessible information includes service plans and assessments. The timeline view allows users to view service involvement over months or years, and also provides some context for that information by showing life events such as the birth of a child.
The “Outcomes Tool” allows authorized users within DHS to see how programs are performing. Right now, this tool works only for the education, justice and child welfare systems but it gives DHS staff the ability to analyze a segment of a population that is involved in one of these systems—such as a cohort of people who have been in the jail and meet other criteria of interest like a history of receiving emergency shelter services and mental health treatment—and then monitor their outcomes, like reconviction or rebooking.
In collaboration with the Stepping Up initiative, the Data-Driven Justice initiative and the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge, the Substance Abuse and Mental Health Services Administration (SAMHSA) convened a Best Practices Implementation Academy to Reduce the Number of People with Mental Illnesses and Substance Use Disorders in Jails BPIA) in April 2018 in Alexandria, Va. At the BPIA, delegations from 24 jurisdictions involved in one or more of the three initiatives met to showcase best practice strategies and advance implementation efforts to prevent or reduce the jail involvement of individuals with mental illnesses and substance use disorders.
This case study is part of a series highlighting the six counties that constituted the “Best Practices” teams representing the Data-Driven Justice initiative and the Stepping Up initiative at the BPIA.