A state-funded program aimed at improving services for people with behavioral health challenges is showing promising early results, according to an independent evaluation by the Center for Health Systems Effectiveness at Oregon Health & Science University.
Researchers found that the initial launch of the Improving People's Access to Community-based Treatment, Supports and Services, or IMPACTS, program was associated with fewer criminal convictions and lower recidivism, or fewer people released from prison committing additional crimes, along with increased initiation and engagement in substance use treatment.
Commissioned by the Oregon Criminal Justice Commission, the evaluation focused on the program's first two-year grant cycle (July 2020 – June 2022). The Oregon Legislature created IMPACTS in 2019 to help counties and tribes provide more responsive, community-based behavioral health services – particularly for people with a history of cycling through the justice or emergency health care systems.
"Oregon continues to have some of the highest rates of mental illness and substance use in the country, and services haven't been able to keep up with the need," said John McConnell, Ph.D., director of the center and a professor of emergency medicine in the OHSU School of Medicine. "Programs like IMPACTS represent a new approach — meeting people where they are and focusing on community-based solutions."
IMPACTS taps local wisdom to meet needs
The IMPACTS program aims to reduce criminal justice system involvement, emergency health care services utilization, and institutional admissions for the targeted population. A total of five tribes and 11 counties have received funding to date. The program is designed to be flexible, allowing grantees to tailor services to local needs and cultural contexts.
Tribal grantees often prioritize culturally grounded case management, family and community-based support, and coordinated care. The Confederated Tribes of Warm Springs, for example, is using IMPACTS funds to help transition individuals from custody to community-based services.
Several county grantees have created diversion and case management teams based in jails or emergency departments, helping people access treatment at key crisis points. In Douglas County, an Intensive Care Coordination team operates in the jail and the emergency department, collaborating with services in the community.
This flexibility in local program design distinguishes IMPACTS from various other state initiatives that are more prescriptive in their approaches.
Promising early outcomes
The Center for Health Systems Effectiveness used a novel dataset of linked Medicaid claims, circuit court filings, incarceration records, and state psychiatric hospital stays to analyze outcomes for individuals with a behavioral health diagnosis and frequent criminal justice involvement or high intensity health services.
Evaluators compared outcomes over time for members of this target population who live in areas served by IMPACTS programs to those living in regions of the state without IMPACTS programs, and found the program to be associated with:
- 47.3 fewer felony and misdemeanor convictions per 1,000 people per year, with a growing gap over time between IMPACTS and non-IMPACTS areas.
- A 1.7 percentage point decrease in one-year recidivism rates associated with new convictions, compared to a baseline rate of 25.1%.
- Increased initiation (4.4 percentage points) and engagement (2.2 percentage points) in alcohol or other drug treatment – despite longstanding challenges in reaching Medicaid enrollees.
- A modest increase in civil admissions to the Oregon State Hospital (0.5 per 1,000), amid broader system-level changes and capacity constraints.
Changes in emergency department visits and hospital days differed across grantees but were not statistically significant overall.
"Our evaluation shows that targeted, locally driven investments can make a meaningful difference," said Stephanie Renfro, M.S., associate director at the Center for Health Systems Effectiveness and lead evaluator. "Across a range of justice and health care outcomes, we saw measurable improvements that suggest real impact for people with complex needs."
Renfro, principal health services researcher Christina Charlesworth, M.P.H., and their team will continue the statewide evaluation as the initial programs mature and new grantees launch services. A second phase of the analysis, covering the program's full first four years (July 2020 – June 2024), will include all grantees and provide a more comprehensive assessment of longer-term outcomes. Meanwhile, the OHSU-PSU School of Public Health is conducting complementary qualitative interviews and local program analysis.
