Looking To The Future – California Health Report


Incarcerated people walk down a hall at Century Regional Detention Facility. Photo by C. Miller, Los Angeles County Sheriff’s Department.

The beginning of this five-part series by WitnessLA looked at the statistics and history of incarcerating pregnant people and women in Los Angeles and nationally, and introduced readers to Los Angeles County’s unique Maternal Health Diversion Program. Subsequent parts of the series, went step-by-step through the pregnancy diversion process which starts in jail, and ends with permanent housing, and looked at ways in which that process can get knocked off track. Later, we learned of the experiences of individual mothers participating in the program — stories of living unhoused, of frequent incarceration, of being pregnant in jail, and of life after the diversion program.

Now, the final part of the Pregnant Behind Bars series explores the pressing need for LA’s Office of Diversion and Reentry to scale up its diversion capacity, and why, thus far, the money to do so hasn’t been there.

Between the inception of the Maternal Health Diversion Program in mid-2018 and October 2021, the Los Angeles County’s Office of Diversion and Reentry (ODR) diverted 200 pregnant and postpartum people out of LA’s jail system. Across all of its diversion programs, ODR has removed approximately 7,000 people from jail since 2015.

Yet, despite ODR’s importance to the county’s efforts to build up community-based care, the office is operating on a financial deficit and against a population cap for its supportive housing programs, including the life-altering Maternal Health Diversion Program. 

How we got here

In the last few years, the supervisors have passed various motions aimed at improving care for women involved in the justice system. One of the programs born from this push — and the larger effort to increase diversion, reduce jail populations, and improve outcomes for justice-system-involved people — is ODR’s Maternal Health Diversion Program.

As described in earlier chapters of this series, the Maternal Health Diversion program pulls pregnant people from the county’s women’s jail, the Century Regional Detention Facility, and places them in interim group housing until they’re ready to move into their own permanent housing with their children. All the while, participants receive a broad array of services and health care to help them in what is often a fundamental life transition.

In August 2019, the board of supervisors made an historic commitment to reducing the county’s reliance on incarceration, by canceling a $1.7 billion contract to build a new men’s jail, and agreeing to implement a “care-first, jail-last” system. 

That same year, the county’s Alternatives to Incarceration Workgroup (ATI), issued 114 recommendations critical for building this new care-focused model. Among the recommendations focused on reducing the impact of the justice system on women and LGBTQ+ people were strengthening reunification efforts for families involved in the child welfare system, creating services and interventions to reduce the prevalence of substance use-related criminal charges, and expanding violence prevention and crisis mediation programs.

The workgroup also recommended developing and expanding pre-arrest and pre-booking diversion programs.

Yet, the road to reform is long and requires substantial funding if the county hopes to make the kind of fundamental changes the supervisors talk about, and which Maternal Health Diversion represents. 

The budget and ODR

The good news is that the board members have taken some important steps to increase spending on the kind of community-based care Maternal Health Diversion represents, especially in 2021. 

For example, at the beginning of the year, the county completed the construction of a Care First Village, a facility now in operation with 232 interim housing units located on a Chinatown lot previously intended to serve as a parking garage for the locked facility that would have replaced the dungeon-like Men’s Central Jail, had the county not voted to dump the jail replacement plan.

The Care First Village, just down the street from Men’s Central Jail and Twin Towers Jail, was set up to prioritize people facing homelessness, formerly incarcerated people, and others in need. This housing comes with services designed to improve residents’ mental health and well-being, increase employment, and reduce recidivism. 

In April 2021, when the LA County CEO released its initial recommended budget for fiscal year 2021-2022 for the county — the first publicly released budget draft of the year — the county was slated to spend $156 million on “Care First, Jail Last” initiatives. The majority of the money — $100 million — was from Measure J, a ballot measure approved by voters in 2020, with the purpose of permanently setting aside at least 10 percent of locally-controlled revenues to be directed to community investments and alternatives to incarceration. 

Then, through budget revisions, along with the release of the supplemental budget in October, the “Care First, Jails Last” pot of money grew to $461.5 million of the county’s $39.3 billion budget. 

The $461.5 million is split between a wide array of initiatives, a number of which go “upstream” from incarceration. For example, $10 million will go to LA County’s Crisis Call Center to help launch 988, the alternative to 911, through which emergencies will be answered by non-law-enforcement responders.

Another $20 million will go toward expanding the county’s Psychiatric Mobile Response Teams (PMRT) — unarmed clinicians trained to respond to mental health crises, instead of law enforcement.

Still other slices of the pie were earmarked in the final budget for interventions and services that reach people in need at different stages of the justice system. 

Some of that $461.5 million for “Care First” will go to the LA County Sheriff’s Department and LA County Probation for law-enforcement-run programs. 

Advocates within the Re-Imagine LA County Coalition have repeatedly criticized county leaders for failing to meaningfully engage the communities that are potentially most affected by such reforms, when deciding how to spend the $461.5 million.

“It’s critical we ensure the county actively seeks the perspectives of Black, Brown, and Indigenous folks and other Angelenos,” according to Re-Imagine LA. These residents should be “central to budgeting decisions about care and services,” but have “historically been excluded from these consequential conversations.” 

Community groups also continue to argue that the county should not be spending such a large portion of its budget on law enforcement — $3.4 billion for the sheriff’s department and approximately $1 billion for the probation department.

Additionally, some recent actions taken by the supervisors have started to lean more toward a tough-on-crime approach. 

Supervisor Kathryn Barger, for example, announced in December that she would spend $1 million in discretionary funds to increase the presence of the sheriff’s department in unincorporated areas. The goal, Barger said, was to stop thefts and robberies “increasingly committed in the public eye” by “criminals [who] feel bold and untouchable.”

Trouble on the horizon

While the Office of Diversion and Reentry received $173 million in the county’s 2021-2022 budget, an increase from $142 million the previous year, that money does not make adequate room for expansion, and the pot of one-time funding for the office is due to run out during this fiscal year. 

In June 2021, the LA County Supervisors called on the CEO to look into alternative ways to sustain and expand ODR, including dipping into state health funding.

During that June meeting, Supervisor Sheila Kuehl stressed that sustaining ODR’s jail-based diversion is critical to the future closure of Men’s Central Jail. “We won’t be able to close MCJ without sustaining this team.” 

At the same time, Kuehl said, the county needs to “keep sight of the fact that expanding a community-based system of care … will demand significant resources at all junctures of the sequential intercept model” — not just at the point of intervening once a person is already in jail, which is ODR’s interception point. 

By the time the supplemental budget arrived in October, the county had increased the amount of money that ODR would receive such that the office’s structural deficit was reduced from nearly $100 million to $42 million. 

ODR is responsible for “an important slice of the continuum” of justice reform, Supervisor Kuehl said while discussing the supplemental budget during an October 5 meeting. 

However, local officials and community advocates believe that simply maintaining ODR is not enough; expansion is critically important.

One of the obstacles to such expansion, is the fact that ODR’s housing-focused programs have been all but closed off to new clients since the office reached an LA County CEO-imposed 2,200-bed population cap, which the bulk of ODR’s programs hit in April 2021.

Matters are not helped by the fact that ODR received no separate money to create the Maternal Health Diversion Program, so had to use existing housing funds. In other words, this meant the diversion initiative became yet one more program drawing from a pot of money subject to the housing cap, according to Dr. Kristen Ochoa, Medical Director of ODR.

These are permanent supportive housing programs, Dr. Ochoa said. In other words, her office works to keep people in ODR housing “forever, if and until they can become completely independent.” 

The “forever housing” approach can be life saving according to the women who went through the Maternal Health Diversion program whom we interviewed.

Bernadette Campos was facing 32 years in prison before ODR stepped in to help. Without the program and the motivation of wanting to be a good mother to her baby, Campos said, “I’d have never straightened up. I would either be doing 32 years, or I’d be dead somewhere.”

Yet, this policy, along with housing caps and other budget constraints, means that too few slots open up for new clients. Thus, ODR can’t take on nearly as many pregnant people, people with mental health issues, and others who would qualify for housing programs, according to Ochoa.

A 2020 Rand Corporation report about mental health diversion in the LA County jail system estimated that 76 percent of those held in the county’s women’s jail had mental health needs, and could be safely diverted. That percentage would, of course, include pregnant people. The study showed that across the entire jail system, only 5 percent of people who were likely good candidates for diversion were actually being diverted. 

But even before ODR hit the problematic population limit, one of the problems the diversion system faces is its inability to get people out of the jails and into care quickly.

Waiting in jail

ODR requires diversion participants to plead guilty, accept a conviction, and go on formal probation. While most of the pregnant people who are offered diversion accept these terms, some decline if they expect to be quickly released to their loved ones. Others may decline because they want to fight their charges.

Those who agree to participate are subject to an often lengthy court process.  

An October 2021, 125-page report from the JFA Institute, a justice and corrections research firm hired by the county to aid with the closure of Men’s Central Jail, found that while ODR’s diversion programs produced low recidivism rates, they could help more people if they were not so “selective in their admission criteria,” and if it did not take so long “for the courts to release eligible people from the jail to the community programs.”

The issue of long case processing times leaving ODR participants sitting in jail for extended periods was brought up in another October report, this one a report back from the LA County CEO, to “support pretrial reform.”

This report revealed that ODR’s diversion programs had pretrial detention periods that ranged “from a median of 60 days for the Maternal Health program to 166 days for the Department of State Hospitals Diversion program.”

At some point, said Judge Peter Espinoza, the recently retired head of ODR, “we are going to get good enough at this to develop a pretrial release model for pregnant women.”

To put it another way, if ODR did find a way to shift some of its diversion efforts toward a pretrial release model, if the office received more of the funding it needs, and if the CEO lifted the housing population cap, there would be room for ODR to serve more people. 

One mother, Michelle Loest, said that despite being arrested many times, participating in multiple drug programs, and having social services involved with her family, she never received the help she needed until ODR invited her into the Maternal Health Diversion program. 

“I think that if I would’ve had an opportunity to be in a program like this before, I probably wouldn’t have gotten in any more trouble, and I probably would have actually been able to start to change my life,” she said. 

“I feel bad that this program is not available for everybody.”

This series by WitnessLA’s assistant editor, Taylor Walker, was produced as project for the USC Annenberg Center for Health Journalism’s 2021 California Fellowship.