Abstract
BACKGROUND: Data-driven decision-making is an implementation strategy to improve system performance and health outcomes for individuals with substance use and mental health needs interacting with criminal-legal systems. We currently have limited understanding of how agencies define and use data in their decision-making processes. A qualitative study was conducted with agency leaders from jails, probation and parole, and community mental health and substance use service agencies to characterize (1) how respondents defined data and data use, (2) current level of data use for decision-making, (3) data capacity needs, and (4) agency perspectives on best practices and their recommendations. METHODS: In-depth interviews were conducted with 68 mental health, substance use, jail, and probation leaders from a representative group of 52 U.S. counties from December 2020-March 2022. Data were analyzed using applied thematic analysis. RESULTS: Four themes emerged. For defining data and data use, respondents characterized their current level of data use as rudimentary. In terms of current level of data use, individual-level health or legal information needed to coordinate services, and risk prediction scores were used over system measures. Data capacity needs identified as capacity to track and share data across agencies and inadequate data management. In terms of best practices and agency recommendations, participants highlighted the need for data sharing, standardized data management systems, data dashboards, and in-house data expertise. CONCLUSION: Findings from this study highlight the limited capacity of counties to implement data-driven decision making in mental health, substance use, and criminal legal settings. Addressing gaps in infrastructure, staffing, and data expertise will require technical assistance and targeted policy incentives. System-level metrics and benchmarks, such as the cascade of care, are essential for evaluating cross-agency performance and improving outcomes for individuals with mental health needs.