The Los Angeles Diversion, Outreach, and Opportunities for Recovery (LA DOOR) program is designed by the Los Angeles City Attorney\u27s Office (LACA) to provide a comprehensive, health-focused, preventative approach that proactively engages individuals at elevated risk of returning to LACA on a new misdemeanor offense. In this study, the authors document the findings of a process and outcome evaluation of Cohort 2 of the LA DOOR program

Holliday, Stephanie Brooks

Labriola, Melissa M

Sims, Heather

Sobol, Danielle

English

DigitalCommons@The Texas Medical Center

Rand Health Q. 2023 Sep; 10(4): 4.Published online 2023 Sep 15.PMCID: PMC10501826PMID: 37720070Implementation and Outcome Evaluation of LA DOOR: A Proposition 47-FundedProgram in Los Angeles: Cohort 2 Final Evaluation ReportMelissa M. Labriola, Danielle Sobol, Heather Sims, and Stephanie Brooks HollidayCopyright © 2023 RAND CorporationShort abstractThe Los Angeles Diversion, Outreach, and Opportunities for Recovery (LA DOOR) program is de-signed by the Los Angeles City Attorney's Of ice (LACA) to provide a comprehensive, health-fo-cused, preventative approach that proactively engages individuals at elevated risk of returning toLACA on a new misdemeanor offense. In this study, the authors document the  indings of aprocess and outcome evaluation of Cohort 2 of the LA DOOR program.Keywords:	Crime and Violence Prevention, Criminal Justice, Los Angeles, Mental Health Treatment,Recidivism, Social Services and Welfare, Substance Use Disorder PreventionAbstractThe Los Angeles Diversion, Outreach, and Opportunities for Recovery (LA DOOR) program is aProposition 47–funded program designed by the Los Angeles City Attorney's Of ice (LACA) to pro-vide a comprehensive, health-focused, preventative approach that proactively engages individualsat elevated risk of returning to LACA on a new misdemeanor offense related to substance use,mental illness, or homelessness.This study documents the  indings of a process and outcome evaluation of Cohort 2 of the LADOOR program, covering services provided from January 2020 through February 2023. The goalof this evaluation is to better understand how the LA DOOR program was implemented and exam-ine the effect of the program on various outcomes. This study describes an overview of the pro-gram, evaluation methods, the logic model that guided the evaluation,  indings from stakeholderinterviews and client focus groups, and analyses of program data. Qualitative interviews and focusgroups revealed key strengths and challenges of the program and focused on speci ic challengesof operating during the coronavirus disease 2019 (COVID-19) pandemic. Analyses of quantitativedata describe the population of clients who are receiving LA DOOR services, the needs of that pop-ulation, and the services provided. Together, these  indings shed light on opportunities for futureprogram implementation and evaluation.Interested stakeholders of this report include LACA, the California Board of State and CommunityCorrections, and the City of Los Angeles, as well as other entities that provide supportive servicesto criminal justice populations or that might be interested in implementing a similar program.The Los Angeles Diversion, Outreach, and Opportunities for Recovery (LA DOOR) program is de-signed by the Los Angeles City Attorney's Of ice (LACA) to provide a comprehensive, health-fo-cused, preventative approach that proactively engages individuals at elevated risk of returning toLACA on a new misdemeanor offense related to substance use, mental illness, or homelessness.Through Proposition 47 (the Safe Neighborhoods and Schools Act), the California Board of Stateand Community Corrections (BSCC) provided initial funding in 2017 to develop LA DOOR. In 2019,BSCC provided a second round of funding from Proposition 47 to a second cohort of select juris-dictions to either expand existing services or propose new programs. Programs funded throughProposition 47 are intended (1) to serve individuals with a history of criminal justice involvementand mental health issues or substance use disorder (SUD) and (2) to offer mental health services,SUD treatment, and diversion programs for justice-involved individuals (California Board of Stateand Community Corrections, 2016).In January 2020, LA DOOR received additional funds for Cohort 2 to enhance and expand the LADOOR model from South Los Angeles into Central Los Angeles, furthering the program's efforts toaddress existing service gaps, reduce recidivism, and prioritize public health solutions to addictionand mental illness. This second cohort serves  ive hotspots in South and Central Los Angeles.Hotspot	locations are areas identi ied by LACA as having persistent open-air drug use and a highdensity of individuals struggling with substance use, mental health, or co-occurring disorders. LADOOR deploys a multidisciplinary social service team to  ive hotspot locations (a different oneeach weekday) to proactively engage individuals with a broad array of social services. The threemain goals of LA DOOR are toincrease clients' utilization of community-based support servicesremove clients' legal barriersreduce recidivism through preventative services and prebooking diversion.Individuals who enroll in LA DOOR have access to a variety of services, includingmental health servicesSUD treatmenthealth and wellness checkslegal serviceshousing servicespeer case management services.Over the course of the project, Proposition 47 grantees are required to collect data and evaluatetheir programs. As with Cohort 1, LACA selected the RAND Corporation and KH Consulting as itsevaluators. As part of the evaluation efforts, grantees submit a  inal evaluation report to assessprogress toward the goals and objectives of their programs. During Cohort 2, LACA has continuedits partnership with Special Service for Groups' (SSG's) Project 180 as the primary LA DOOR socialservice provider, as well as with West Angeles Community Development Corporation (WACDC)and its subcontractor, L.A. Global Care, to provide additional housing and case managementsupport.This  inal evaluation report for Cohort 2 documents the program evaluation results, focusing onthe time frame from January 2020 to February 2023.  The goal of this evaluation is to better un-derstand how the LA DOOR program was implemented and to examine the effect of the programon various outcomes. This study describes an overview of the program, evaluation methods, thelogic model that guided the evaluation,  indings from stakeholder interviews and client focusgroups, and analysis of program data. Qualitative interviews and focus groups revealed keystrengths and challenges of the program and focused on speci ic challenges of operating duringthe coronavirus disease 2019 (COVID-19) pandemic. Analyses of quantitative data describe thepopulation of clients who are receiving LA DOOR services, the needs of that population, and theservices provided. Together, these  indings shed light on opportunities for future program imple-mentation and evaluation.MethodsQuantitative MethodsService	Now	(SNow)	data	analysis. In designing LA DOOR, LACA committed the project andits partners to robust and detailed data collection. SNow is a relational database platformcommonly used by government entities within the City of Los Angeles. LACA, in partnershipwith the City of Los Angeles's Information Technology Agency, built the Health InsurancePortability and Accountability Act (HIPAA)-compliant SNow database to track caseloads amongsocial service partners and track social service access for program clients. The SNow databasefollows social service engagement within several categories: general needs, case management,substance use services, mental health care, physical health care, employment services, housingservices, and legal services. In addition to the SNow database, data on intensive outpatientprogram (IOP) visits, criminal justice history, public defender interaction, and recidivism wereused. Included in this evaluation are eligible LA DOOR clients from January 1, 2020, throughFebruary 15, 2023.  The  inal sample of individuals included 1,102 clients.LA	DOOR	client	feedback	survey. Between September 1 and October 12, 2022, the researchteam and LA DOOR partners distributed the client feedback survey (in person and by email) tocurrent and past clients to collect quantitative feedback on the perceived effectiveness andimportance of LA DOOR services.Qualitative Methods123LA	DOOR	client	focus	groups. Between October 18 and 25, 2022, the research teamconducted  ive in-person focus groups and one virtual focus group with LA DOOR clients togather qualitative input and feedback regarding the clients' LA DOOR experiences. Each focusgroup was between 45 and 60 minutes in length and covered a variety of topics, such asmotivation for participating in LA DOOR; client experiences with LA DOOR programs, services,and staff; and challenges and suggestions for improvement.LA	DOOR	partner	interviews. In October 2022, researchers held a total of six in-person andvirtual interviews with LA DOOR partner staff involved with LA DOOR Cohort 2 clients.Interviewees were asked for their perspective on (1) different aspects of LA DOOR; (2)implementation barriers and facilitators; and (3) implementation components andimplementation processes, including service planning and decisionmaking, service selection,development and maintenance of partnerships, communication among partners, and program-monitoring efforts.Participant	observation. During the multi-day visit to LA DOOR, researchers observed LADOOR activities as participant observers, which included observing both an intake session atProject 180 and case management sessions at both Project 180 and WACDC and a ride-alongwith the LA DOOR mobile team to a hotspot location.Key FindingsThe following are the key  indings in this Cohort 2  inal report:LA DOOR enrolled 1,102 individuals, which makes the program well positioned to meet theanticipated total caseload of 750 clients during the grant cycle.In 59 percent of cases, LA DOOR accomplished its goal of working with each client for at leasttwo months after enrollment. Clients who were active in program services for two months areconsidered as having completed the LA DOOR program, though they can continue to participatein the program after that time.LA DOOR clients represent a hard-to-treat population with important psychosocial needs: 62percent of clients had SUD and co-occurring mental health conditions (most commonly notedas depressive disorders, bipolar and related disorders, schizophrenia and other psychoticdisorders, and trauma or stress-related disorders). In addition, many LA DOOR clients lackstable housing and income sources.LA DOOR clients reported that housing continues to be a signi icant need; both quantitativedata and focus groups suggest that clients found housing services to be among the mostimportant LA DOOR services. In addition, clients expressed concerns about the dif iculty ofnavigating the bureaucratic processes associated with being linked to transitional andpermanent housing, unsanitary and unsafe shelter conditions, and long wait times for Section 8housing.LA DOOR project staff and partners discussed the many challenges related to service accessand availability during the COVID-19 pandemic: heavy caseloads, lack of LA DOOR–fundedtraining, decreased COVID-19–related services, cumbersome bureaucratic processes, andincreased medical needs (primarily because of fentanyl use).LA DOOR partners maintain program  idelity, and LA DOOR clients continue to expressgratitude for and high satisfaction with LA DOOR and the services it provides.This  inal Cohort 2 report provides LA DOOR partners the opportunity to re lect on the implemen-tation of the project and to learn more about the clients who are being served and the servicesthat are being provided.NotesThis study is one of a series of closely related RAND publications on this topic (see Labriola et al., 2021, and a futureCohort 3 report). These closely related studies share some material, including descriptions, figures, and tables.Public defender data, data on prebooking diversion clients, and criminal history data are limited to the period fromJanuary 1, 2020, through October 31, 2022.Throughout this study, LA DOOR partners specifically refers to LACA, Project 180, and WACDC (including L.A. GlobalCare).The research described in this article was sponsored by the California Board of State and Community Corrections andconducted in the Justice Policy Program within RAND Social and Economic Well-Being.References1. California Board of State and Community Corrections Proposition	47	Grant	Program	Request	for	Proposals. 2016. , ,2. Labriola Melissa M., Sobol Danielle, Holliday Stephanie Brooks. and Sims Heather . Final	Evaluation	of	LA	DOOR:Proposition	47	Grant	Program. RAND Corporation; 2021. https://www.rand.org/pubs/research_reports/RRA1500-1.html, , , , , As of April 27, 2023: [PMCID: PMC9519108] [PubMed: 36238013]123

Implementation and Outcome Evaluation of LA DOOR: A Proposition 47-Funded Program in Los Angeles: Cohort 2 Final Evaluation Report

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Implementation and Outcome Evaluation of LA DOOR: A Proposition 47-Funded Program in Los Angeles: Cohort 2 Final Evaluation Report

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