Patching holes and bridging gaps

Abstract

Introduction: Law Enforcement Assisted Diversion (LEAD) is a pre-arrest diversion program that allows police officers to refer individuals to LEAD's harm reduction case management services in lieu of arrest for most lowlevel, non-violent criminalized behaviors. The program assesses participants' needs for resources and services and facilitates referrals and ongoing support to meet these needs. In this qualitative study, we examine the influence of service availability and accessibility on the implementation of North Carolina's LEAD programs. Methods: We conducted in-depth, semi-structured interviews with 49 participants across four well-established LEAD sites, including LEAD partners (n = 27) and LEAD participants (n = 22). We analyzed the data using a blended inductive/deductive coding strategy. Findings: Participants' narratives highlighted several important challenges related to service provision and linkage in communities with a dearth of service options. Findings were captured in four main themes. First, in some communities, certain resources and services were completely unavailable. Second, even when communitybased resources and services were available, they were often perceived as inaccessible by participants for a variety of reasons. Third, LEAD programs and staff worked intensely and flexibly to increase access to community-based resources and services. Finally, there was widespread agreement that resource scarcity disrupted the continuum of care, thereby causing some participants to disengage from LEAD and related services as their readiness for change fluctuated. Conclusions: The efficacy of diversion programs, including LEAD, depends not only on their high-quality implementation and fidelity to existing models, but also on successful coordination and linkage to a range of comprehensive, easily accessible and sustainable community-based resources and services. When communitybased resources are unable to meet basic needs and support the continuum of care for people with substance use disorders, LEAD staff and participants will struggle to meet expectations and programs will be unlikely to optimize outcomes.