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Chapter 1

What is LEAD?

A Model, Not a Program

The LEAD model is founded on evidence-based core principles. While aspects of the model have evolved over time, the core principles have remained stable and are time-tested. Protracted, significant departure from these elements in any LEAD site would mean that it is not operating LEAD with fidelity.

However, there is considerable room for local adaptation while still adhering to the core principles. Indeed, fitting the model to address the foremost issues faced by each community is a LEAD core principle. Throughout this toolkit, LEAD core principles are indicated by an orange caret to the left. The entirety of the core principle is indicated by a line that descends from the indicator on hover.

Although the toolkit notes other areas of adaptation or augmentation that may be advantageous or of interest, they are not requirements.

This is a Core Principle

Advancing Safety

LEAD advances safety, health, and equity by equipping communities with a better way to respond to issues flowing from unmet behavioral health needs and extreme poverty, for which revolving-door arrest, prosecution and incarceration are both common and ineffective.

Structured Collaboration

Most social problems are more complex than any one entity or sector can address by itself. Recognizing this, LEAD uses a form of structured collaboration – called collective impact – in which diverse stakeholders commit to a common agenda to solve a complex problem.

Using this framework for multi-agency collaboration…

  • The policies and protocols for each LEAD site are developed by local decision-makers and advocates who make up the Policy Coordinating Group; they may include senior law enforcement officers, prosecutors and public defenders, project managers, business representatives, elected officials, civil rights leaders and community advocates.
  • For operational coordination and case conferencing, line-level personnel, including mid-level supervisors, make up the Operational Work Group. The project manager, police officers, assistant prosecutors and public defenders, case managers, other service providers, and community leadership representatives all come to the table.
This is a Core Principle

Who Makes LEAD Happen?

Too often, health and safety initiatives are developed and decided by public officials and agency leaders with little meaningful input from the community about its priorities, ideas, needs, or transparency. But people in every community are affected by problems caused by unmanaged behavioral health issues, poverty and homelessness, and everyone has a real stake in seeing a robust, fair, effective framework for response to these issues.

Business Community

As members of the larger community, business owners and employees are important stakeholders in LEAD. They may have long-standing, first-hand experience of the disruption and suffering associated with people living with unmanaged behavioral health needs, poverty and homelessness, and they can be essential partners in understanding the priorities and strategies for a local LEAD effort. Small businesses in vulnerable communities have often experienced under-service, and can be particularly important champions of a community-based response that commits to addressing the safety issues they encounter.

Community Members

LEAD intentionally cultivates and includes diverse stakeholders – in addition to business owners, civil rights and disability rights advocates, residents associations, mental health and recovery services providers, faith communities, and public safety coalitions – to develop and manage each LEAD initiative, and be alert for the various ways in which an effort like this could falter. To formalize this inclusion, many LEAD sites establish Community Leadership Teams (CLT) to contribute to its collective stewardship.

Criminal Legal System Entities

LEAD allows criminal legal stakeholders to participate in a better response to problems for which jail and prosecution are generally ineffective, and consume system resources unnecessarily.

Police officers, public defenders, prosecutors, and probation agencies are key partners in the LEAD model: developing policies and protocols as members of the PCG, drawing on their professional positions to illuminate emerging needs, problems and opportunities; and supporting multidisciplinary case review and problem-solving by participating in OWG and case conferencing.

Operational Partners

Given LEAD’s collaborative and dynamic model, multiple organizations may have a role in implementing or partnering in a LEAD initiative. In addition to the project management entity and the case management provider, these can include LEAD Liaison Prosecutors who coordinate LEAD participants’ non-diverted cases; sergeants and officers making diversion referrals in the field; public defense managers identifying missed opportunities for diversion; other community-based service providers; public health systems; and other agencies responsible for training, education, employment, public benefits, and family services.

For partners involved directly in implementation – those who sit on the PCG and/or the OWG,, LEAD initiatives develop a multi-agency Release of Information (ROI) to enable partners to share information as necessary and appropriate.

Other Interested Stakeholders

Other agencies and groups may not hold a primary operational responsibility but are important stakeholders nonetheless; these might include mayors, councilmembers or commissioners, state legislators, business leaders particularly impacted by the problems of unmet behavioral health needs, civil rights and disability rights advocates, faith organizations committed to providing support where they can, or vocational organizations that might provide opportunities for LEAD participants.

Thus, while it is useful to recognize the distinctions between operational partners and what might be called interested stakeholders, it is important to ensure that LEAD informs, includes, and benefits from a wide array of stakeholder organizations. Many can and will help shape local attitudes and practices through legislation, advocacy, community engagement and education, and civic leadership.

This is a Core Principle

Who Are LEAD Participants?

LEAD is designed to provide care coordination for people with complex, ongoing, unmet behavioral health needs and/or income instability who may lack shelter/housing, income, food, health care, and social networks and for whom existing systems prove inaccessible, impossibly complicated, or insufficiently responsive.

Public intoxication, persistent trespass, open-air drug use, shoplifting – research shows that more than 60% of people in custody are held for offenses like these.1Zhen Zeng, Jail Inmates in 2017, bulletin prepared at the request of the Department of Justice, Bureau of Justice Statistics, April 2019.2Ibid. In many cases, these persistent behaviors are driven by unmanaged mental illness, substance use, or poverty.

Individuals may be referred to LEAD if they are exposed to the criminal legal system due to illegal activity related to behavioral health issues or poverty. LEAD is primarily designed for people who have had repeated contact with the criminal legal system, whose problematic situation is entrenched and protracted, related to complex challenges – it is not a “light touch.”

But someone can be referred into LEAD even if the criminal legal system hasn’t actually responded in a specific instance, or even if the referred individual doesn’t have a criminal history. This is because although the criminal legal system fluctuates in its ability and desire to respond to issues such as these, the public typically expects law enforcement action for these behaviors, unless another kind of response is available.

Why Does LEAD Exist?

LEAD is designed to help communities build a different system of care and response to better address the challenging realities we face:

Policies criminalize unmet behavioral health needs.

Two-thirds of the people arrested in this country have a mental illness or a drug dependency3Jeremy Travis, Bruce Western, and Steve Redburn, eds., Committee on Law and Justice, Division of Behavioral and Social Sciences and Education, National Research Council, The Growth of Incarceration in the United States: Exploring Causes and Consequences (Washington, DC: The National Academies Press, 2014). 4Ibid.. In many communities, arrest and incarceration – rather than investments in community-based services – have long been the default response to these challenges. Even when those punitive systems recede after the realization that this response is counterproductive, other strategies are rarely in place to truly address illegal and problematic conduct related to drug use, mental illness and poverty–creating a void that isn’t sustainable. While punitive responses are a poor and harmful match to these conditions, cause great harm and foster inequity, it is not enough to just divert away from those systems – there must actually be a framework for care coordination that is up to the task and is broadly received as legitimate.

Jail isn’t just ineffective, it’s harmful.

Studies show that being jailed even for a short time increases a person’s risk of engaging in crime,5Todd R. Clear, “The Effects of High Imprisonment Rates on Communities,” Crime and Justice 37, no. 1 (2008), 97- 132. decreases employment and tax related government benefits,6 Will Dobbie, Jacob Goldin, and Crystal S. Yang, “The Effects of Pretrial Detention on Conviction, Future Crime, and Employment: Evidence from Randomly Assigned Judges,” American Economic Review 108, no. 2 (2018), 201–240. 7Alexi Jones and Wendy Sawyer, Arrest, Release, Repeat: How police and jails are misused to respond to social problems, August 2019. increases homelessness,8 Lucius Couloute, Nowhere to Go: Homelessness among formerly incarcerated people (Northampton, MA: Prison Policy Initiative, 2018). and exacerbates the racial disparities embedded into our society.9Becky Pettit and Bryan Sykes. (2017). “State of the Union 2017: Incarceration.” The Stanford Center on Poverty and Inequality. For people with mental illness or substance use disorder, the impact of jail is even more detrimental: They may be taken off Medicaid, receive inadequate care in custody, are more likely to be sanctioned for rule infractions, are subjected to harsher sentences, and are disproportionately returned to jail.10Darrell Steinberg, David Mills, and Michael Romano, When did prisons become acceptable mental healthcare facilities? (Stanford, CA: Stanford Law School, n.d.). The devastating intergenerational impact on children when their parents are jailed, even for short periods, is well-documented.11Nell Bernstein, All Alone in the World: Children of the Incarcerated (New York: The New Press, 2007).

Overuse of the criminal legal system exacerbates racial inequities.

Across the country, communities have recognized that our longstanding reliance on policing and prosecution as the primary response to an array of profound social needs has had a deeply disproportionate impact on people of color. Less well known is the fact that most criminal legal system reform efforts also tend to primarily benefit more affluent people and white people – even when such reforms are adopted in the name of advancing racial justice. LEAD is designed to intentionally intervene before many cases reach the criminal legal system, providing a satisfactory alternative response. LEAD also uses data and process checks to ensure that resources and benefits reach the same population that has been disproportionately subject to punitive responses in the past.

This is a Core Principle

A Better Paradigm

LEAD starts by diverting people with behavioral health needs, pre-booking, away from jail and prosecution and into collaborative, community-based systems of response and care.

LEAD’s Strategy…

...addresses unmanaged mental illness and substance use.

LEAD builds a community-based alternative to jail and prosecution for people whose unlawful behavior stems from unmanaged substance use, mental health challenges, or extreme poverty.

...does not require abstinence.

Unlike other forms of diversion, such as divert-to-treatment and most drug courts, LEAD’s harm reduction-based approach doesn’t impose sanctions, establish deadlines, or require abstinence. LEAD is aligned with SAMHSA’s definition of recovery:

“Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.”

Thus, health supports, a stable and safe place to live, purpose, meaning, and community should be understood as essential elements of a recovery journey. For some participants, that journey may – but not always – entail abstinence from non-prescribed substances, and the recovery path will generally include multiple instances of relapse and struggle.

In LEAD, case management provides a “golden thread” that supports all aspects of a participant’s recovery journey, whatever shape it takes. The LEAD model recognizes, however, that participants often confront abstinence requirements in other systems they encounter. In such events, case managers should provide the best support they can to help participants successfully navigate such requirements, even though they are not a feature of LEAD itself.

This is a Core Principle
...nurtures incremental progress.

LEAD’s approach is grounded in the evidence of what works best to support recovery and behavior change for people with complex needs and high barriers. As social science tells us, a person’s readiness to change their behaviors follows no steady course – it can come slowly, may suffer setbacks, and is sparked by internal motivators; with behavioral change, it’s often two steps forward, one step back. Trauma responses make this even more challenging, as self-sabotage, lack of positive self-regard, fear that success foreshadows future loss, anxiety, and trust barriers can cause reactions that, from the outside, look irrational and contradictory.

The criminal legal system – with its public processes, engagement which always entails at least an implied threat of punishment, sanctions, and generally impersonal relationships – isn’t built for that. But LEAD is. LEAD uses trauma-informed, strength-based case management, evidence-based methods, and harm reduction practices to spark and nurture incremental progress and increase safety. In addition, these techniques generate better and nuanced information that then can guide criminal legal system partners who may exercise authority over participants in non-diverted cases; this may help avoid decisions that may inadvertently hamper participants’ progress.

This is a Core Principle
...offers a third way as an alternative to punishment and abandonment.

With LEAD, communities work together to reorient the way their systems understand and respond to people living with unmet behavioral health needs and income instability. Rather than either punishing people for their unmet needs or turning a blind eye to the troubles on our streets, LEAD draws together into collective effort the stakeholders whose systems otherwise receive pressure to respond in traditional, but often counter-productive, ways. It is not enough just to reduce use of those systems – rather, LEAD provides an alternative answer to the very real problems of individuals and communities that result in a high volume of low-level but detrimental illegal and problematic behavior.

What Makes LEAD Different?

  • LEAD is not a program, but rather a framework to arrive at the best response to problems – it increases public safety by creating a new system of collective response.
  • LEAD is not a short-term crisis response – it offers ongoing case coordination for people with complex needs living in situations that generate ongoing problems.
  • LEAD isn’t operated within the legal system – it’s a community-based collaborative that can coordinate in many ways with the legal system to achieve better outcomes.
  • LEAD doesn’t mandate treatment, abstinence or any particular care approach; rather, it is based on harm reduction principles and uses motivational interviewing and other evidence based strategies for working with a high barrier population with complex needs. All care plans are highly individualized.
  • LEAD serves a specific population otherwise potentially exposed to punitive responses – people whose frequent unlawful or problematic conduct stems from unmet behavioral health needs or income instability, extreme poverty or homelessness.
  • LEAD isn’t office- or clinic-based: it reaches people wherever they might be, physically, mentally, and behaviorally.
This is a Core Principle

Origin and Development of LEAD

2008: The start of a pre-booking alternative in Seattle

In 2008, after years of contentious advocacy and litigation focused on racially disproportionate enforcement for drug activity (possession and delivery) in Seattle, the Racial Disparity Project at the Public Defender Association (now known as PDA), the ACLU, the Seattle Police Department and the King County Prosecutor embarked on a surprising new road together: they began working together to create a pre-booking alternative for most drug and prostitution cases. They found early support from some Seattle City Councilmembers and King County Councilmembers, the then-King County Sheriff, and the Seattle City Attorney. By the time the initiative received an initial round of funding from the Ford Foundation, Vital Projects Fund, and the Open Society Foundations, it had gained the endorsement of the Downtown Seattle Association, several prominent recovery organizations, local neighborhood leaders, and leading civil rights advocates.

2011: The creation of LEAD and the Belltown pilot

In 2011, this uncommon coalition launched a new model to divert people away from jail and the legal system and into harm reduction-based case management at the earliest opportunity: at or before the point of arrest. By making law enforcement and prosecutors operational partners rather than just operating “upstream” from those entities, this coalition ensured that LEAD would effectively intervene in the flow of individuals who were unnecessarily and unproductively entering the jail and courts. They named it LEAD: Law Enforcement Assisted Diversion. As the nation’s first pre-booking diversion initiative for drug offenses, the pilot program launched in Seattle’s Belltown neighborhood; in the ensuing years, and with the support of the city of Seattle and King County, it was steadily expanded to additional neighborhoods and neighboring jurisdictions over the years.

In the early months of the Belltown pilot, it became evident that, while individual participants entered LEAD as the result of police diversion, most already had other non-diverted cases and warrants, or they faced new cases filed after their enrollment. The LEAD team realized that those other charges and warrants often threatened to upend progress painstakingly achieved by participants and case managers. Thus, prosecutor coordination of non-diverted cases with the individual case management plan was a feature of the model almost from the outset.

2015: A national LEAD summit at the White House

The Obama Administration convened a national LEAD summit at the White House in 2015, bringing multi-disciplinary teams from 25 jurisdictions together for two days of workshops on the essential elements of the model and key elements of each operational and governing partner’s role.

2020: The possibility of LEAD referrals without police involvement

When police capacity to response to low-level offenses was nearly eliminated in the early months of the COVID pandemic, and in the context of national calls for new approaches to public safety in the aftermath of the murder of George Floyd, Seattle/King County LEAD stakeholders recognized that it was essential to ensure community partners could make referrals to LEAD services without the need for police involvement – though police referrals are still preserved as a priority part of the model. This evolution was named LEAD: Let Everyone Advance with Dignity, and was quickly adopted by many jurisdictions around the country.

Evolving the LEAD Model

LEAD’s adaptability has been persistently evident in the flagship LEAD initiative in Seattle. From its first pilot in Belltown, throughout its expansion and national replication, and in shifting political and social environments, the LEAD model can adapt and thrive to meet the needs of the given time and place.

CoLEAD: Intensive case management in lodging

In 2020, recognizing that many public order offenses were occurring in conjunction with large encampments that increased during the COVID economic shutdown, and that shelters, health clinics, libraries, community centers, courts and jails were also largely shuttered, PDA and other Seattle-King County LEAD partners redirected existing unspent program funds to provide intensive case management in a non-congregate shelter setting in hotels. Named CoLEAD, the model proved highly successful in engaging people with high barriers living unsheltered in Burien, a neighborhood adjacent to Seattle.

JustCARE encampment resolution & intensive support

Building on the CoLEAD experience, and using federal COVID relief funds, in late 2020 other service partners joined in with PDA in 2021 to offer JustCARE, a response that resolved encampments in vulnerable Seattle neighborhoods by doing protracted outreach, assessment, and resource matching while offering non-congregate shelter resources to chronically homeless individuals, almost all of whom experienced substance use disorder, and most of whom faced other barriers to housing and care systems, including involvement in the illicit economy. Three service providers offered intensive case management to hundreds of individuals, and a community-based safety team was formed to support non-police de-escalation and incident response in JustCARE facilities. Between autumn 2020 through spring 2022, JustCARE resolved 14 large encampments in three Seattle neighborhoods, lodging over 500 people, achieving high rates of permanent housing placements, and losing no participant to overdose death.12An Analysis Of JustCARE Housing And Other Outcomes

Third Avenue Project/milieu management & multi-partner care model

In 2022, after most large encampments in Seattle’s downtown core had been resolved, individuals with complex behavioral health needs who were engaged in illicit economic activity remained present in the area, with obvious needs for support and care and posing significant public order challenges for downtown businesses and workers. Neighborhood leaders and city officials asked LEAD partners to propose a strategy, one that recognized the need for a milieu management situational response in addition to long term individual case management. The company that had been formed to provide safety team and de-escalation services for JustCARE lodging facilities agreed to mobilize teams to engage individuals in the area who were exposed to enforcement, deescalate potential conflicts, provide milieu management for challenging dynamics, and connect individuals to appropriate service providers, including LEAD case management. PDA’s LEAD project management team provides project management for the Third Avenue Project as part of their downtown Seattle LEAD focus impact work.