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Chapter 4

How LEAD Works

Building a “Second Response”

Diversion away from the criminal legal system is an essential option for first responders – but diverting people from arrest is only one of the three doors into LEAD services & care coordination.

Even in communities that have developed an array of first responders options – police officers, crisis intervention teams, co-responder programs, or non-police alternatives – the question often remains: after the first response, what do we do next? (This is often phrased as “divert to what?”)

Regardless of which “front door” is used, a large percentage of people traditionally and futilely pulled into the criminal legal system need a substantial second response: sustained care, development of a participant-focused, harm reduction care plan, and cross-system coordination with the multiple entities that intersect with the individual.

With LEAD, community stakeholders – officers, health agencies, community-based service providers, elected and appointed officials, advocacy groups, businesses, and interested residents – work together to build an effective, coordinated “second response,” one that reorganizes existing pieces and adds others to identify and address the needs of people whose persistently disruptive or unlawful conduct stems from unmet behavioral health needs or poverty.

This is why LEAD can serve as a universally accessible and valuable “second response,” regardless of what the first response landscape looks like in a particular community.

Further, LEAD provides an ongoing framework to coordinate with legal system partners and others who often have other involvement LEAD participants; this regular, multidisciplinary coordination reduces the chance that the left hand will undo the progress the right hand has labored to achieve.

This is a Core Principle

Case Management

LEAD-style case management is the heart and soul of this intervention, a golden thread to form trusting relationships with people for whom standard models of care just aren’t effective, adeptly supporting them in navigating these complex systems as long as it takes to achieve stabilization and healing.

LEAD case managers represent the lifeline by which participants begin to find steadier footing. It can take days or weeks – providing a bottle of water and a pair of socks on one day, or arranging medication, being present for the birth of a child, or forestalling eviction on another – for case managers to begin to forge transformative connections. LEAD case management meets participants where they are, physically, mentally and emotionally, and uses evidence-based practices to achieve behavior change by building strengths and capacity while allowing participants to aim at goals that are most meaningful to them.

Lived Experience/Peer Staff and Clinical Skill

There are many paths and experiences that can equip a LEAD case manager with the skills and capacities essential to excellent case management. Both lived experience and superb clinical skill are essential – any LEAD team requires both.

Although lived experience is not essential for every member of the team, having people with lived experience with behavioral health needs, homelessness, and/or criminal legal history on the team is invaluable: it fosters connection and credibility with participants and provides insight into participants’ experiences and how systems actually function.

However, LEAD participants also should expect high levels of clinical skill and knowledge about diagnosis, symptom identification, emerging treatments, medical resources, and housing system navigation; thus, the whole team should have access to skilled clinical supervision.

Field-Based Case Management

Rather than being offered only in offices or by appointment, LEAD-style case management also operates in the streets, to literally and figuratively meet people where they are. Of course, case managers need office time to battle for resources for their participants, and participants are welcome to visit the office “home base,” but the model assumes that the team doesn’t just wait for participants to come to them – rather, the team is dedicated to connecting with people in the field as often as needed.

This is effective for engaging highly marginalized people, and it gains the trust of officers and neighborhood leaders who can see the teams respond to problems officers constantly encounter. For an officer, seeing a case manager come to an alley in the early morning hours to receive a warm handoff for someone struggling with substance use and homelessness lays a strong foundation for a lasting partnership.

Flexible and Non-Coercive

With their commitment to client-driven harm reduction, LEAD case managers don’t impose expectations or deadlines; they don’t require abstinence or demand compliance. Instead, LEAD’s client-driven case management is flexible, adaptive, patient, ongoing, and holistic. Because it also lasts as long as necessary, participants’ goals should be expected to change over time. Someone who started off wanting to get ID and work on housing may move on to working on medical issues; eventually, some may ask for help accessing inpatient treatment resources, even years into the relationship. LEAD’s adaptable, patient, participant-driven case management is intended to foster and support these evolving goals.

Criminal Legal Alignment

Legal System Coordination

The primary focus of LEAD is to ensure people are not unnecessarily jailed and referred for prosecution for unlawful conduct related to their behavioral health challenges or poverty. To that end, LEAD case management must prioritize pre-booking, pre-arrest, or community diversion referrals.

In addition to the referral charge, LEAD participants may have other non-divertible (or just non-diverted) old cases, old warrants, old cases newly-filed, and new cases, for which LEAD services are still the best response. LEAD is not supervised by courts or probation. However, LEAD provides invaluable legal-system coordination with courts, probation, and prosecutors in filed cases. LEAD case managers may provide information on participants’ new or existing cases to courts, probation officers, and prosecutors, which may inform decisions about whether to decline to file charges, whether or not to detain or seek pretrial detention, whether to dismiss charges, and whether to recommend or grant a favorable disposition. LEAD can also accept referrals from courts, probation or prosecutors, pursuant to local law, while recognizing that those agencies and actors have long been able to make community referrals or social contact referrals.

It is important that sites avoid the circumstance in which people have greater access to services, support, and resources when they are moved further along in the Sequential Intercept Model (for example, via drug court) than they would have via a community-based, pre-booking context. Otherwise, systems are operating with perverse incentives to send people unnecessarily further into the legal system just to get access to support and services.

Prosecutors

Since prosecutors, by law, retain full authority over prosecutorial decisions, only they can ensure that pre-existing cases and warrants, as well as subsequent cases, are coordinated and aligned with a participant’s intervention plan related to any diverted case. But prosecutors’ hands are not tied, and LEAD participation confers no immunity from prosecution on other cases. However, LEAD partner prosecutors recognize that pursuing another case in a standard fashion could actually compromise all the progress that case managers and prosecutors have made with the individual. Thus, prosecutors often find it best to creatively and individually resolve non-diverted cases whenever possible to maximize the benefit of LEAD case management and avoid destabilizing participants.

It is typical that people who enroll in LEAD will carry with them unresolved criminal cases and warrants from the past, including cases that might now be divertible into LEAD. In LEAD, prosecutors are encouraged to support the coordination of participants’ pre-existing cases and warrants, as well as non-diverted post-enrollment cases, with the participant’s individual intervention plan. In this way, they help ensure that the left hand (prosecution of non-diverted cases) isn’t unwittingly undoing the good work of the right hand (case management in lieu of filing other cases).

Not prosecuting a charge against a LEAD participant isn’t “doing nothing.” To the contrary, information on the status of prior or subsequent charges for a LEAD participant should be shared among members of the OWG, which can use its regular meetings to discuss a participant’s overall progress, and brainstorm about the approach that would best support behavior change, which in some cases might entail dismissing an old or a newer charge, holding the case to monitor progress and then dismissing if the participant has stabilized, foregoing a detention motion, supporting a warrant quash, or specific case resolutions short of dismissal. However, while prosecutors benefit from hearing the insights of other partners and particularly the case manager, the question of how to handle the non-diverted cases is always at their discretion. Making those thoughtful decisions requires dedicated prosecutor capacity in most jurisdictions, though it adds no cases and likely reduces case volume.

“Post-enrollment cases” stem from new arrests or charges after a participant enrolls in LEAD. It should be noted that some post-enrollment cases could, confusingly, relate to incidents that took place before enrollment but that may have sat in a filing queue for weeks or months before filing. It is also common for people enrolled in LEAD to be arrested again after they entered the program, as the arc of recovery is long, change takes time, and progress is not linear.

Decisions about both pre-existing cases and post-enrollment charges should be informed by the LEAD’s Golden Rule #2: Within their zone of authority and while considering insights provided by other LEAD stakeholders, every LEAD partner should do what they believe is most likely to support positive behavior change in the specific circumstances.

This is a Core Principle
Public Defenders

LEAD was originally co-designed by a public defense office that managed a dedicated Racial Disparity Project. Intrinsic to the model is the understanding that defense involvement can provide substantial reassurance to civil rights advocates that this process – in which case managers share information with police and prosecutors – is operating within guardrails and will not harm participants’ interests.

Public defenders are essential eyes and ears in a LEAD ecosystem.

Public defenders are the best guardians of the first Golden Rule that “no one can be worse off because they participated in LEAD.” They may be the first to notice that, in subtle ways, LEAD participants appear to be subjected to more aggressive prosecution attention, or are seeing cases filed against them that would not typically be filed. Should that occur, it is crucial for defense attorneys to immediately alert project managers, so they can bring the dynamic to the attention of LEAD partners for discussion and response.

Public defenders are also best situated to notice missed opportunities for diversion – that is, diversion-eligible charges that resulted in jail booking and prosecution for no clear reason. Such instances may illuminate opportunities for police training and increased awareness of the diversion process. Defense attorneys can also help identify patterns in diversion and referral for prosecution such as racial disparity, geographic gaps in the diversion map, or absence of diversion activity in a particular police unit.

Public defenders also can be among the best informed to make referral recommendations. Often, defenders have clients whose current cases are resolved but who appear at risk for further entanglement in the criminal legal system unless they get some excellent, timely help.

Line-level public defenders are unlikely to have time available to participate in the meetings and case conferencing that LEAD entails, and they may develop awkward ethical conflicts issues if they learn, in LEAD workgroups, information about co-defendants that their own clients could use to their advantage. Thus, it is often best for the “eyes on” public defense representative in the OWG (and perhaps the PCG as well) to be an emeritus representative of the sector, someone in the central administrative office, or someone otherwise removed from active client representation or supervision of attorneys with active caseloads.

This is a Core Principle