Determining the Populations of Focus

By reviewing this section of the guide first responders will be able to:

1. Understand the important challenges and promising practices that other programs have used to decide who their deflection and diversion programs will serve

2. Recognize the public health principles that guide delivery of services within deflection and diversion to a wide range of individuals who use drugs

3. Consider issues with inclusion and exclusion criteria for each component of your deflection and diversion program

One of the first key decisions deflection and diversion program implementers must make is to define the population that will be eligible for participation. Two principles guide this determination.

1. Deflection and diversion programs seek to provide services to the broadest population of individuals at risk for drug abuse. The initial emphasis for programs had been opioid use, but now, most programs address all substances, including alcohol, mental health disorders, co-occurring disorders, and other social issues.

2. All individuals are deserving of services. There is no public health justification for excluding individuals based on criminal history or other justice-system statuses.

Section A: Define Eligibility Requirements & Populations of Focus

Program parameters should be the least restrictive to ensure all pathways are available for individuals needing help with problematic substance use, even though many deflection and diversion programs define eligibility parameters depending on the pathway to resources.

For example, a post-overdose follow-up program will narrow the population to those that have experienced a recent non-fatal overdose. An intake program will have the broadest target population because it aims to create pathways to treatment  for most individuals with substance use disorders that contact program sites for assistance. Certain street outreach programs might focus on areas known to have populations of people who use drugs with a different set of criteria for inclusion. Overtime, many programs incorporate multiple pathways to broaden their reach.

Section B: Select Exclusion Criteria

Program developers also frequently specify exclusion criteria for various components of the model. Exclusion criteria are often based on organizational capacity, real or perceived demands of local policymakers, state regulations, or external funding requirements. Several characteristics are often debated in the context of program implementation, including:

i) existing warrant status

ii) offense types committed at point of contact, if applicable

iii) other existing supervision status (e.g., parole or probation), and

iv) criminal history prior to point of contact.

There is little guidance about the appropriateness of these criteria for program success.

Section C: Warrant Status

One important area to consider is the practices around warrant checking, a policy which can have substantial implications for connecting people to treatment through deflection and diversion programs. A 2019 survey of Massachusetts Police Departments found that 57% of post-overdose outreach programs checked warrants prior to outreach. Of this majority, 19.6% of post-overdose outreach was performed without addressing warrants, 15.9% was delayed until warrants were cleared, 8.0% ended in arrest of the survivor, 7.2% took a situational approach, and 6.5% ended up not performing outreach.[46] Ultimately, warrant checks can cause barriers to providing services for overdose survivors. Warrant checking and police participation should be established at the discretion of each program and/or on a case-by-case basis. If warrants are to be checked, there should be a clearly defined and communicated procedure that officers take.

Promising Practice Recommendations

Avoid including warrant status as exclusion criteria, particularly for intake, outreach, and overdose follow-ups. Checking warrants may be more appropriate for pre-arrest diversion, and the practice is virtually unavoidable in most post-arrest diversion procedures.

If you are required to check warrants due to state or local policy, have a process in place that allows for discretion from higher ranking staff or one that would allow the local court to re-docket cases when possible.

The Hope Not Handcuffs program procedures explicitly state that the warrants “may” affect eligibility and that shift supervisors have the discretion to allow participation based on several factors.

The Safe Passage program in Illinois had a process in place for officers to contact the state’s attorney, which resulted in most of the existing warrants being vacated.

The Plymouth County Outreach program has recovery coaches conduct follow ups by phone in the event that a warrant exists, ensuring that individuals with warrants have the opportunity to clear up their warrants or have access to services the same way an individual without a warrant would.

Section D: Offense Types at Point of Contact

Individuals might be in possession of drugs or drug paraphernalia when they arrive at an intake site or when contacted through outreach activities in public or private spaces. Intake and outreach programs should minimize barriers to access treatment and recovery and should not exclude individuals who are voluntarily seeking resources, while in possession of drugs or drug paraphernalia. However, implementing agencies must decide on the appropriateness of diversion for certain offenses in addition to drug possession when conducting enforcement activities and pre-arrest diversion practices.

Promising Practice Recommendations

Avoid overly restrictive exclusion criteria around offenses committed during the contact. For example, possession of illegal substances or paraphernalia offenses should not be added to exclusion criteria for any deflection components of your comprehensive model. This ensures a more inclusive and effective approach, addressing underlying issues and promoting harm reduction within the framework of diversion. 

Assess the offense types added to exclusion criteria with data from existing sources. Existing pre-implementation arrest data is a window into determining how exclusion criteria will affect the number of people eligible for deflection and diversion programs. 

Build discretion into your exclusion criteria based on offense type criteria. For example, the MARI program in Madison, WI, allows exceptions with approval from higher-level staff. For more information, refer to the policy and procedure section.