Breaking the Cycle of Incarceration With Targeted Mental Health Outreach: A Case Study in Machine Learning for Public Policy

Many incarcerated individuals face significant and complex challenges, including mental illness, substance dependence, and homelessness, yet jails and prisons are often poorly equipped to address these needs. With little support from the existing criminal justice system, these needs can remain untreated and worsen, often leading to further offenses and a cycle of incarceration with adverse outcomes both for the individual and for public safety, with particularly large impacts on communities of color that continue to widen the already extensive racial disparities in criminal justice outcomes. Responding to these failures, a growing number of criminal justice stakeholders are seeking to break this cycle through innovative approaches such as community-driven and alternative approaches to policing, mentoring, community building, restorative justice, pretrial diversion, holistic defense, and social service connections. Here we report on a collaboration between Johnson County, Kansas, and Carnegie Mellon University to perform targeted, proactive mental health outreach in an effort to reduce reincarceration rates. This paper describes the data used, our predictive modeling approach and results, as well as the design and analysis of a field trial conducted to confirm our model's predictive power, evaluate the impact of this targeted outreach, and understand at what level of reincarceration risk outreach might be most effective. Through this trial, we find that our model is highly predictive of new jail bookings, with more than half of individuals in the trial's highest-risk group returning to jail in the following year. Outreach was most effective among these highest-risk individuals, with impacts on mental health utilization, EMS dispatches, and criminal justice involvement.

A Machine Learning System for Retaining Patients in HIV Care

Retaining persons living with HIV (PLWH) in medical care is paramount to preventing new transmissions of the virus and allowing PLWH to live normal and healthy lifespans. Maintaining regular appointments with an HIV provider and taking medication daily for a lifetime is exceedingly difficult. 51% of PLWH are non-adherent with their medications and eventually drop out of medical care. Current methods of re-linking individuals to care are reactive (after a patient has dropped-out) and hence not very effective. We describe our system to predict who is most at risk to drop-out-of-care for use by the University of Chicago HIV clinic and the Chicago Department of Public Health. Models were selected based on their predictive performance under resource constraints, stability over time, as well as fairness. Our system is applicable as a point-of-care system in a clinical setting as well as a batch prediction system to support regular interventions at the city level. Our model performs 3x better than the baseline for the clinical model and 2.3x better than baseline for the city-wide model. The code has been released on github and we hope this methodology, particularly our focus on fairness, will be adopted by other clinics and public health agencies in order to curb the HIV epidemic.