Episode 25_Zgierska_Balles_Nachtigal 
Part 1 
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[00:00:06] Michael Donovan: Welcome to the Evidence to Impact podcast, the podcast that brings together academics and their research partners to talk about insights and real world policy solutions in Pennsylvania and beyond. I'm Michael Donovan, the associate Director of the Evidence to Impact Collaborative here at Penn State University.

[00:00:23] Michael Donovan: In this episode, we'll be discussing a concept of bridging the gap. Community policings role in recovery and crime reduction. My guests today are Dr. Alexander Ska from Penn State. Captain Joe Boas, retired from the City of Madison, Wisconsin Police Department and the MPDs MA project Coordinator from 2017 to present. 

[00:00:49] Michael Donovan: And lastly, captain Diana nautical, captain of Community Outreach with MPD in Wisconsin. Thank you all for being here today. Really, really very much appreciate. Your contributions to this. Today we are going to be talking about the Madison Airy Area Recovery Initiative, or ma, initially funded by the US Department of Justice, the development of the program outcomes, and then the evolution over, uh, about 10 years from MA 1.0 to MA 3.0, the current manifestation.

[00:01:23] Michael Donovan: Maybe we'll just get started here. , Dr. Ska, could you give us kind of an introduction on, why you do what you do and your background?

[00:01:33] Aleksandra Zgierska: Uh, hello everyone. Uh, I'm Alexandra Ska. I'm currently at Penn State College of Medicine where I am a, a faculty member professor at, uh, the Department of Family and Community Medicine. I am a researcher and physician specializing in family medicine and addiction medicine, but prior to coming to Penn State, I will add right before the pandemic, so that was an interesting, um, experience on its own.

[00:02:07] Aleksandra Zgierska: Uh, I was a faculty member for uh, in, in, uh, uh, uh, worked at. University of Wisconsin in Madison for about two decades. So long time to get to, which allowed me to get to know, um, everyone in the community, but also in the, uh, research and academic settings. Uh, at that time I was also a president of the Wisconsin Society of Addiction Medicine. 

[00:02:37] Aleksandra Zgierska: And in that role I, facilitated annual conferences on addiction. Uh, we. We're very interested in broadening the scope of those conferences and general collaborations to include people from all, and professionals from all walks of life who interact with individuals with addiction. So, at that time, I got to know my colleagues from the Madison Police Department who, worked specifically with, people with addiction who committed, crime.

[00:03:15] Aleksandra Zgierska: And so that led to those next steps. So serendipity in life, through the initial collaboration, we, they've. Felt comfortable approaching me to put together with them and with the police departments. , Incredible grant writer Jim Powell. It was, captain Jason, Friedman and Captain Cory Nelson, who approached me to, help with the submission on so-called smart policing in response to the smart policing initiative and funding issued by the, US Department of Justice.

[00:03:55] Aleksandra Zgierska: We sometimes forget that addiction affects so many sectors, of our society, but also individual human, family, community life. And, police officers have experienced, a lot of, uh, challenges with addressing , people with addiction who might commit crime related to, their drug use. So, they really looked for, we're looking at that time for innovative approaches to reduce, we call it revolving doors of, arresting a person who committed this kind of crime.

[00:04:36] Aleksandra Zgierska: Maybe the, the person spent some time in jail and here , Dr. Ballas and, NAL can add. How the process typically, traditionally looked like from their firsthand experience as, police officers. But then these individuals were released back to community and invariably, and we did research at that time to not only think that that's what's happening, but document that that's what's happening.

[00:05:05] Aleksandra Zgierska: And saw that, uh, yes. On its own with this traditional approach, individuals keep coming back into the criminal justice system and keep committing crime. And maybe I'll pass the baton here to, captain Ballas who, uh, can speak from the police department and, law enforcement perspective how the pandemic of opioid overdose and opioid misuse and addiction, was, experienced through the lens of the police officers.

[00:05:41] Joseph Balles: Thanks, Alexandra. I, um, so I got involved. Michael Ja Alexander referred to Captain Jason Friedman and Captain Corey Nelson. I want to just point out that this all occurred back around 2015 and Corey and Jason had just completed stints with the Dane County Narcotics and gang task force. And in that time in the police department, this was about 10 years ago, we were on the beginning end of the, or beginning front of the, opioid epidemic and particularly heroin, was largely, the predominant drug at the time that was leading to overdoses., As I was preparing to lead the department at the time, I retired technically in January, 2016. , We had a young officer in the department name was Carrie Hemmings. She was a part-time EMT in another community, but the Madison Police Department was one of the first, large departments around the country to have every officer trained in, administration of Narcan and Naloxone.

[00:06:39] Joseph Balles: That was. That was Drake really leading edge kinda stuff. So we had a police department that was already seeing the opioid epidemic in a different way than a lot of other police departments around the country. So when Alexandra meets Jason and Corey at this Wisconsin Society for Addiction Medicine Conference in Madison, that was where the kind of the brainchild for ma Galk started coming together.

[00:07:03] Joseph Balles: The, I wanna speak for a moment about the SPI, the Smart Policing Initiative program that the US Department of Justice operates that, uh, started ma um, that was started back in 2008 under the Obama administration. And the whole idea behind it, Michael, was to bring researchers and evidence-based practices together with practitioners out in the community.

[00:07:22] Joseph Balles: And I think for this podcast that is so, . Important to understand that's, that was the magic, that was the magic sauce of how we brought this all together. Dr. Ska and getting a true principal investigator, research partner here was our collaborator for four years. As we were able to do basically a very good, implementation of what we believed to be best practice at the time, and then thoroughly evaluate it to the point where we could actually publish several papers now in different academic, journals, peer reviewed, um, and.

[00:07:56] Joseph Balles: Now tell the story about what we did and the impact we know that programs like MA can make. , I just wanna kinda put that out there in that context. And we're so fortunate and I've had the great honor of working with Alexander for almost a decade now. And, it's just, uh, really fun what we've been able to do and not just do, and we're talking a lot about Maori 1.0 today, but Captain Nco being here, I mean, this program has continued to evolve and there's a lot of police departments around the country that get grants to do things for two or three years, and that's a long time.

[00:08:25] Joseph Balles: And then once the grant money goes away, it's done. But we've been fortunate to say, sustain this through our, our grant writing powers, uh, with Jim Powell and others, and, really kinda keep this, uh, program growing and evolving. So I'll pause there and, Michael, I'll let you. Go where you want to go next.

[00:08:41] Michael Donovan: Yeah, sure. I, and I'd love to hear, just a, a introduction , from Captain Nautical as well, the captain of community outreach at MPD currently. So we have, the kind of longitudinal perspective beginning, back in even 2008, with the beginnings and then 2015 and 16 and now moving this into, current, uh, current events.

[00:09:01] Michael Donovan: So Captain Nautical, 

[00:09:04] Diana Nachtigal: good morning. Yes., I'm Captain Diana nautical. I've been with the Madison Police Department since 1998, as a police officer for 21 years. I've worked, you know, various roles within the department, so I'm the newest member of the, the Maori team, and I came in under Maori 3.0 and I'm really looking forward to carrying this forward, and making this program sustainable and.

[00:09:30] Diana Nachtigal: Part of my passion for this project is that it really aligns with some of our core values for the police department. As far as community partnerships, uh, I really enjoy the collaboration that the department, is doing with some of our, organizations in the community that are supporting and working with people with substance use disorders.

[00:09:51] Diana Nachtigal: And then it also, aligns with our commitment to evidence-based policing practices. So I am really excited to be a part of this initiative and to see what we can do to make this sustainable in the future. 

[00:10:05] Aleksandra Zgierska: And Diana, you touched down on sustainability and that was at the forefront of our thought from the very beginning.

[00:10:14] Aleksandra Zgierska: So, it would be an , omission, not to mention that element from the get-go. We succeeded and we know that we succeeded because the program continues, through today, and there is no plan to stop it. , We also were able to implement it, evaluate it, and then publish on it. But this wouldn't have happened, if not, uh, a very deliberate approach.

[00:10:42] Aleksandra Zgierska: We started from the beginning or implemented upfront and I wanted to emphasize it because. This way of implementing projects is very uh, frustrating for many people. We spend about a year walking door to door, literally the team to make sure that the entire, that the leaders in the community are not only aware of the program, but are on board and can provide feedback on how to best implement it.

[00:11:17] Aleksandra Zgierska: We posted, a kind of job or contract posting to find a treatment provider who would provide evaluations within community settings. And, we were , fortunate to, work with connections counseling , whose team members went above and beyond to help make this program happen and work hand in hand with police officers on tracking the outcomes of the program.

[00:11:48] Aleksandra Zgierska: We had strong support and it nothing would've happened if that wasn't in place from the Chief of police at that time. , Mike Koval our supports through, variety of personal channels and com of communication, but also the green lighting and support on this higher level allowed us to also, have complete buy-in and support from the city mayor, from the district and city attorney's offices.

[00:12:23] Aleksandra Zgierska: We couldn't, like, as a researcher, I can't just tell somebody, Hey, we'll waive your crimes for you and your criminal charges. This was not up to me. So we were worrying a little bit how long it was taking to build this broader community engagement. And we had listening sessions with, uh, open to everyone in the community.

[00:12:48] Aleksandra Zgierska: We had meetings of, we call stakeholder partners to get feedback and optimize the program. Not only criteria, but also , day-to-day delivery. This was a pragmatic project, so we also kept improving on whatever we are doing as we kept going, within, our like allowed improvements. This was also a, a res had research portion, so we couldn't make, we couldn't do everything.

[00:13:19] Aleksandra Zgierska: And change the game plan because we went into it, uh, with certain plan and criteria. And later on, Mari iterations were able to learn from it. And each iteration is better than the prior one. More responsive to the community needs, but also trying to, uh, address whatever challenges and barriers we noted in this first iteration.

[00:13:49] Aleksandra Zgierska: We, had some champions within the community and, uh, and we reached out to really broad, uh, range of partners. And one of them was, health Plan w uh, EEA Trust with Tim Bartolo, who was tirelessly championing our program. So. Bottom line is it's not just few of us trying to lead it. , It was a community level support and engagement.

[00:14:21] Aleksandra Zgierska: And Joe at that time, was uh, employed by, safe Communities, which is another community organization, whose goal is harm reduction, injury prevention and community health. Broad effort, but, and this is Joe, where you could maybe address how other programs fared out who did not follow this slow and steady, build the capacity and buy an approach who just tried to make it happen really quickly, because that's what's most, um.

[00:14:56] Aleksandra Zgierska: Satisfying, I guess. Yeah. 

[00:14:57] Michael Donovan: Yeah. , And before, before you jump in, captain BAAs, I was just thinking about how this incredibly time and labor intensive, requirement of community engaged research, really doesn't always map on so well to , the funding opportunities, from our inter our national partners at DOJ, for example, or even, other partners, philanthropic or otherwise.

[00:15:19] Michael Donovan: So that, that is a, a kind of a best fit problem, there as well. You have to really have some dedicated folks willing to put in the time and to really be thoughtful about getting that buy-in. Thinking through, what stakeholders, really are going to be necessary. But please, yeah, we 

[00:15:35] Aleksandra Zgierska: were playing long game.

[00:15:37] Michael Donovan: Yeah. 

[00:15:37] Aleksandra Zgierska: Not just short game. And Joe can also speak because now he's engaged in the, uh, technical assistance program. Team who, uh, worked with us as a part of this grant and was on board with supporting our community engaged approach. 

[00:15:56] Joseph Balles: Yeah, I think I'll, um, I'm gonna jump in here 'cause one of the things I also want to kind of get out there, Michael, for your audience, is what exactly did we do?

[00:16:05] Joseph Balles: , And that's very relevant here. 'cause this era, this time period was, um, two, early 2017 when I officially became involved. And Alexandra, Corey Nelson, there was another captain at the time, Tim Patton from the police department, that was involved. And we basically had this, multidisciplinary agency team that was meeting over at Alexandra's office, over by St.

[00:16:27] Joseph Balles: Mary's Hospital here in Madison. It was those meetings where the brainstorming all happened with regards to how are we, we got the grant. Now we kinda said conceptually what we gotta do. But one of the requirements to the SPI program that BGA had was you had to write an action plan and then get that action approved by our technical assistant providers and the, the Bureau of Justice Assistants.

[00:16:51] Joseph Balles: And that was really where the rubber hit the road because we had to put down the paper what are we gonna do? And, what we came upon, because we really wanted to monitor people, as they went through the program, we ended up, uh, kind of basing ours on a program that was going on a few years earlier out in Seattle called the Law Enforcement Assisted Diversion Project that they, did was Seattle PD and King County.

[00:17:14] Joseph Balles: But basically, um, they realized before us that taking people that are struggling with addiction. Constantly having them go through the revolving jaw of the criminal justice system in their local jail does nothing, absolutely nothing to help a person who's in the depths of addiction. And what Alexander brought to our team and to the department was the beginning understandings of addiction and how we have to look at addiction as a disease.

[00:17:44] Joseph Balles: And we incorporated our model was that police officers, when they respond to a scene, and we had a list of eligible crimes about seven of 'em, prostitute prostitution, theft, uh, theft from model criminal damage, even burglary to a family member's house. 

[00:17:59] Aleksandra Zgierska: All drug when drug use related, right? And by the way, those crimes were approved by all the.

[00:18:07] Aleksandra Zgierska: Attorney offices. Right, right. 

[00:18:09] Joseph Balles: That collaboration Alexander speaks to with the DA's office and the city attorney's office, we had everybody on board that the officers had probable cause to arrest. But we are gonna use our police, our discretion as police officers to not arrest, but to have those charges there available and give them the opportunity to voluntarily meet with our assessment hub, which at that time was connection, uh, run by COL Connections, housing counseling, and they went through a clinical assessment for substance use disorder.

[00:18:37] Joseph Balles: And from that sub, that assessment. Their recommended level of care, wherever they were, fell on that scale. Everybody that we had that went through that assessment tested for, some level of substance use disorder. And, we had people all the way up to resident in need of residential treatment to people that just simply needed some counseling.

[00:18:55] Joseph Balles: Our outpatient, wherever the A SAM process dictated, that's where the level of care we extended people. We wrote what we called a Maori arrest diversion treatment plan for them, and asked them to stick with us for six months. And we also had a peer support component that was tied into this where they paired with a peer support provider, but stick with us for six months and we will, um, help you get and start your way into recovery.

[00:19:23] Joseph Balles: And over the three year period, Michael, we had 263, people that were eligible that Madison Police Officers referred to ma. We had 160. Actually complete clinical assessment, which we think is amazing. 61%. And then of those 160 that completed assessment, 100 of them successfully stayed with us all the way through to the end of six months.

[00:19:45] Joseph Balles: So all the papers that we've written then subsequent to this, and then the project ran for three years, from 2017 to August, 2020. And we followed people for a full 12 months from their referral date to the program, afterwards. It was just really astounding the things that we saw and realized that wow, a just a police department can have such an impact on people's lives and the things that people would write in their evaluations afterwards saying, I never thought my pathway to recovery would ever go through the Madison Police Department.

[00:20:15] Joseph Balles: Thank you so much for this program. Some very, very, very powerful stuff. But in a nutshell, that's what we did. And, uh, and how we did it. 

[00:20:24] Aleksandra Zgierska: Yeah. And differently from many other programs. The criminal charges for a person who entered Maori program, they had not been entered, so they were not in the system because our belief was, and that's how we structured it, that if we can have a person who completes Mari, not have criminal charges on their record, it'll help them get housing, it'll help them get loans, and with variety of other aspects of life that are critical for successful recovery.

[00:21:01] Aleksandra Zgierska: But one of the criteria for successful program completion was not only keep up with treatment. We didn't interfere what it means to keep up with treatment. It was really up to individual treatment providers to tell us thumbs up or down on treatment engagement. And typically if a person was coming to treatment, they don't have to be perfect.

[00:21:25] Aleksandra Zgierska: That was thumbs up. It's mostly when a person simply disappeared from treatment when, we would, consider it disengaged and, disappeared from the program. They also couldn't commit another crime to be considered a successful completers in having their charges at the end of those six months completely voided.

[00:21:51] Aleksandra Zgierska: So their criminal record for the crime that brought them to our program was not, there, was not a part of their, wouldn't come up on their background check. 

[00:22:05] Joseph Balles: It was a big in Wisconsin. Michael, that's a big motivator. We have a public database called CCAP here in Wisconsin. But basically if you, are brought before, uh, arraignment court on any type of misdemeanor or felony level charges, and a lot of times possession of heroin at the time and still is a, a, a class C felony in the state of Wisconsin, you subsequently and make that appearance in court, you go into an online portal that everybody in the world, in Wisconsin or uh, can look search you and see that you were arrested and arraigned on a possession of, uh, heroin charge.

[00:22:39] Joseph Balles: Sure. Um, we, um, the other thing I'll point out too is the, a lot of people don't realize this, but if you get booked into a county jail just by, and don't even end up going to court, but just the process of getting your fingerprints taken, that gets transmi transmitted to your state level. And it's here in Wisconsin, we call it the Crime Information Bureau, but that, um.

[00:23:00] Joseph Balles: Booking into the jail. That creates another arrest record too, in a place that the state of Wisconsin Department of Justice for $10, you can go do a search for anybody and, um, see whether or not they've been booked into any one of our 72 county jails in the state. So what we really tried to do is put up systems in our protocol where we did not create a record based upon some crime that they were committing.

[00:23:24] Joseph Balles: Where it was, the nexus was back to their addiction and substance use disorder. That's been the impetus of this, is to defer and deflect people struggling with addiction away from the criminal justice system. We're not gonna arrest them, but we're gonna really give them a chance to get treatment. 

[00:23:40] Michael Donovan: And , to reduce a stigma as well, that could follow them. I'm wondering as well about, . How Ma has been, and again, for our listeners, ma is the Madison Area Recovery Initiative. Uh, I wanna make sure everyone is fully on our acronyms how that's really been operationalized within the police department from 1.0.

[00:23:58] Michael Donovan: And then, uh, I'd love to hear also how Captain Nautical has really implemented it, with, 3.0 Vision. Now, is there a training, program or protocol associated? , What does it look like? Because it is a, you have, a large police force to, to really drive this home with, right? 

[00:24:13] Diana Nachtigal: Yes, we do.

[00:24:14] Diana Nachtigal: So we have about currently 340 officers in patrol right now. And over the iterations we of Mari we really have worked, I think, successfully to institutionalize this program so that we teach it and have instructional. Time during the Officers Police Academy that, so we, Matt, the Madison Police Department runs our own internal police academy for all new hires, and so we actually have time, our Maori team has time during that instructional period to go out and do a presentation about ma and kind of walk through the entire steps of how the referral process works. 

[00:24:55] Diana Nachtigal: We are always updating the eligibility criteria to kind of meet best practices and go with the evolution of the program as it's expanding. So that's always changing. So we get in right at the beginning of an officer's career to kind of teach them that this d um, diversion program, uh, is in practice and what the parameters are.

[00:25:17] Diana Nachtigal: But then we also do updates at least on a, an annual basis to the entire department, um, but also as. The expansions happen, we meet with all levels of the department to explain and, um, go through the actual changes that are coming.