The Justice and Health Connect Toolkit provides a framework for planning, implementing and sustaining interagency collaboration between justice and health systems. The toolkit is organized into four modules, describing the steps to setting up information sharing initiatives. While the toolkit is presented in a linear format, we encourage you to explore the different sections as your information sharing initiative evolves and progresses based on your interests and needs.
Wherever possible, the toolkit references real-world examples of jurisdictions that have adopted effective approaches to address information sharing challenges, accessible summaries of the research literature, and examples of best practices. In this way, the toolkit provides a different way of accessing information included in the resource library. If you still cannot find what you are looking for or have feedback on the toolkit, contact the Justice and Health Connect Team.
At the outset, you will need to set clear objectives that explain what you hope to accomplish by sharing information. While these objectives may change as you discuss your ideas with others and adapt your plans to accommodate legal and practical considerations, developing an initial vision for information sharing will allow you to communicate your ideas and determine who needs to be involved in initial planning discussions. Moreover, it will lay the foundation for mapping out the legal requirements governing information transfer, drafting data-sharing agreements, and determining your technology needs.
Examples of objectives for justice-health information sharing:
- Improving continuity in provision of health services between community and justice settings;
- Informing outreach efforts for people who will become newly eligible for Medicaid and health insurance subsidies under the Affordable Care Act;
- Reducing reliance on emergency room services by referring people leaving correctional facilities to community healthcare services such as health homes, and providing clinical information to inform their treatment;
- Providing information on health needs to the courts to identify potential candidates for treatment-based alternatives to incarceration;
- Ensuring timely access to essential medications for people entering jail or prison by linking correctional health providers to community healthcare networks.
The next step is to convene relevant stakeholders to start the process of building consensus and mapping out logistics. You should target a group that includes decision makers with the authority to approve and implement policy recommendations.
Click the Justice-Health Information Sharing Stakeholders Checklist to see which stakeholders you may consider including in initial meetings.
Six Guiding Principles:
1. Establish leadership and secure executive support early on.
Support from top-level leadership is critical for the success of information-sharing projects. Executive involvement is crucial when it comes to negotiating budgets, assigning agency staff to support a new initiative, setting priorities and seeking approval to expand the scope of an agency’s mission. Without the political will and buy-in from people in positions of power, interagency initiatives can fail to get off the ground or quickly become unsustainable. Once you have executive-level support from those at the top of organizations, they can delegate technical tasks to members of their staff.
2. Assign joint responsibility for chairing working groups and leading other planning activities.
Ideally, your initial meetings should be co-sponsored by the agencies that will be involved in the information exchange. Working groups that are co-chaired by the heads of both justice and health agencies are more likely to be viewed as collaborative and will be able to draw on resources within the range of partner agencies.
3. Identify legal experts with knowledge of your jurisdiction’s privacy laws.
Personal health information is protected by various federal and state privacy laws that restrict the ability to share information in particular situations and impose requirements for obtaining informed consent (see Module 3 for further details). There is considerable variation in state laws governing personal health information, and the regulations protecting the privacy of mental-health and substance-use information are especially stringent. Therefore, it is important to include people from your health department or treatment community who are versed in federal and state privacy laws.
4. Identify existing interagency groups, including those with prior experience in data sharing.
Your state or local jurisdiction may already have interagency justice and health collaborations, task forces, or steering committees underway, which can provide a foundation for new information-sharing initiatives. Also, many states and local governments have made substantial investments in advancing the use of electronic health records and data exchanges between hospitals and other community healthcare providers. Even if they do not have direct experience with criminal justice information exchanges, representatives from these groups may have already identified and addressed common hurdles to inter-agency collaboration and data sharing (e.g., compliance with state medical privacy laws, technology interoperability). You may also seek advice from local leaders with experience in multi-agency information sharing that are working in contexts outside of health and criminal justice. For example, many states’ child welfare, juvenile justice, and education agencies are collaborating and sharing data, which often includes sensitive information; in order to enhance services for mutually served children and families.
5. Identify boundary spanners.
Boundary spanners are people that work at the interface of health and justice systems, and who understand the common interests, shared goals, and duplicative services, as well as the distinct expectations, culture, and politics of each agency. Boundary spanners can act as liaisons between agencies, and provide important insights into the competing priorities and shared aspirations of health and justice officials. Boundary spanners are people such as community health practitioners working in correctional settings to educate people in prison about health and how to navigate the health system in the community, as they prepare to transition from prison into the community.
6. Involve the consumer community.
It may be important to include representatives from the behavioral health consumer community to help you foresee and plan for any privacy or ethical challenges that may arise. Securing the support of consumer advocates such as a local chapter of the National Alliance on Mental Illness (NAMI) can help ensure that your policies and services adequately reflect the needs of consumers, and will help ensure your initiative abides by ethical guidelines that protect consumer interests and well-being.
Bringing together a diverse group of stakeholders from organizations with different priorities, cultures, institutional responsibilities, and levels of resources can surface tensions that, if unchecked, may derail your initiative. There are a couple of methods that have shown to be successful in overcoming challenges to developing the necessary consensus for interagency collaboration.
Scoping sessions provide an opportunity for agency staff to discuss plans for information exchanges and provide feedback. They can be used to identify potential points of friction and shared priorities by providing a forum for the various stakeholders involved in an information-sharing initiative to discuss objectives, identify key concerns and barriers, and start to lay the framework for foundational documents that establish governance for an information sharing relationship.
Bringing together stakeholders in Hampden County: In Hampden County, Massachusetts, the Association of State Correctional Administrators, and the Bureau of Justice Assistance conducted a series of “scoping sessions” as part of their Jail Reentry Information Sharing Pilot program. The Hampden County Sherriff’s Department invited 26 agencies and community providers to attend a two-day meeting to discuss the value of information exchanges between the county jail and public health community. JH Connect interviewed Bob May, from the IJIS Institute about his experiences working with stakeholders in Hampden County to design and implement information sharing as part of this initiative. Read the interview here.
Drafting a project charter is a useful process for determining stakeholders’ priorities for sharing information, documenting consensus, specifying goals and objectives of data sharing, mapping out the scope of the project, formalizing partnerships between justice and health organizations, and assigning responsibilities. Project charters are important to draft at the outset and can be adapted and modified as your interagency collaboration evolves. Furthermore, charters can set the stage for developing legal documents in the future, including memorandums of understanding, information-sharing agreements, and agency policies that codify information sharing arrangements.
Click here for a practice guide on drafting project charters
The National GAINS Center’s Sequential Intercept Model (SIM) provides a conceptual map of the points along the criminal justice continuum where there may be opportunities to link people with treatment services and share information. A number of jurisdictions have used the SIM as a framework for structuring meetings with stakeholders to build consensus and identify opportunities to increase collaboration between criminal justice and public health systems. Click on the links below to learn how two jurisdictions used SIM to foster collaboration between local health and justice agencies.
At the end of the consensus-building process you should aim to have identified a group of potential partners who agree upon a clear, explicit mission statement that defines what your data-sharing arrangement will achieve. The mission statement is the starting point for working through the rest of the process, including assigning responsibilities, mapping out legal issues, and developing governance documents.