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Quality of Life Archive

In Washington, DC, is childhood asthma part of a poverty trap?

Author: Zach McDade

| Posted: April 17th, 2014




When I was a kid in Boulder, Colorado, one of my soccer teammates had asthma, but, like a lot of kids with that condition, it didn’t slow him down. Although asthma affects nearly 1 in 10 children, it is a well-understood and highly treatable disease.

It’s therefore concerning that so many low-income kids—often black or Latino—in Washington, DC, suffer regular, negative consequences of asthma (among the highest rates in the nation). I suspect that’s because it’s yet another example of the pernicious cycle of poverty. In fact, research shows that children from low-income families have far less control over asthma and higher morbidity from the disease than their higher-income peers.


Evidence is mounting that poverty is a vicious cycle that produces other negative outcomes, which in turn deepen poverty. For example, children born into poverty are much likelier to be poor adults, and so their kids are likelier to be poor. The rise of long-term unemployment has plunged many families into poverty, and being in poverty increases your chances of being unemployed for a long time. Austerity measures like sequestration cuts to unemployment insurance and food stamps all compromise family finances and deepen the cycle.

Is the same thing playing out with asthma in DC? A qualitative study by my Urban Institute colleagues sheds some light on the problem.

Poverty puts up barriers to treating asthma

For DC’s large low-income population, it’s clear that where you live matters for getting effective asthma treatment. Families in many communities have poor access to transportation to the doctor. They also have fewer available doctors. And many low-income, especially single, parents cannot take time away from work during doctors’ business hours.

What’s more, much low-income housing comes with a host of asthma triggers, whether it’s proximity to pollution or other toxins in the neighborhood or, as many interviewees reported, exposure to dust, mold, or other negative conditions within the home.

Asthma can also get in the way of a child’s education because these problems get compounded at school. Low-income kids tend to need even more vigilant asthma monitoring and treatment at school, for which most schools are simply not equipped. And when low-income families either don’t have the resources to get a second school inhaler or the bandwidth to ensure that kids carry one every day, asthma problems can compound at school.

But asthma can also lead to greater poverty

Poverty can worsen asthma, but worse asthma, in turn, can deepen a family’s poverty.

Many parents reported that, in order to care for their children’s asthma, they had to take time off from work. But many low-income parents don’t have paid time off or flexible schedules, so they were fired for taking too much time or quit preemptively because they knew they would get fired anyway.

So, for many families, there is a direct tradeoff between treating a child’s asthma and being employed. If they choose treating the asthma, they can lose their income, making it even harder to get good medical care, move into a healthy home and neighborhood, and afford the necessary medication and equipment to treat asthma.

A byproduct is that those families often end up getting expensive, publicly funded treatment in the hospital’s emergency department.

Can we break the cycle?

To be clear, these stories are anecdotal and do not constitute a statistically sweeping claim. But they add to the growing mountain of evidence that poverty is a trap with a clear conclusion: if we spend money now to break people out of the trap, then they’ll be healthier, more productive and self-sufficient, and in less need of support later.

It’s an investment: spend some now, save more later.

There are some obvious ways to break a poverty-asthma trap. We can more vigorously enforce housing quality regulations and mandate that employees with documented asthma needs be exempted to care for their children. We could also incentivize clinics to maintain non-standard hours and work with organizations like ImpactDC – an emergency department intervention program - to build better asthma-treatment routines into low-income neighborhoods and schools.

Image: Standing outside her home on East Street in downtown Raleigh, N.C., Lonnette Williams, right, talks Wednesday, Oct. 5, 2005, about living in Raleigh's South Park neighborhood. Children living in low-income areas like South Park, which has particularly poor quality air, are at greater risk of asthma problems. (AP Photo/Karen Tam)

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How “zero-sum funding” can impact the whole criminal justice system

Author: Janine Zweig

| Posted: April 16th, 2014



Domestic Violence Safe Houses

In a recent story in The Crime Report, reporter Deirdre Bannon brings to light a critical policy issue that demands our attention: the tensions related to zero-sum funding of criminal justice programs.

Bannon’s story describes how the Department of Justice will penalize states found to be noncompliant with Prison Rape Elimination Act  standards with a five percent cut in federal funding for corrections. However, Bannon also reports the money will be filtered back to states for them to improve practices to become compliant. Sounds good, right?

That is, until you read that these funds “are being taken from a category of grants that support violence against women programs, drug courts, and reentry services so individuals stay out of prison.”

The funding switch could force some states to cut these types of programs entirely, leaving criminal justice leaders across the country with tough choices.

When we offset new funding by cutting established funding, the implications for public safety are problematic at best and harmful at worst, particularly when it comes to serving victims of crime.

For one thing, it asks us to choose between victims. Cutting victim services and programs to prevent and respond to domestic violence, sexual assault, and stalking through the Violence Against Women Act for the sake of programs to prevent and respond to prison rape may leave groups of victims without assistance. All victims have a right to the support and resources they need to recover and move forward after being violated.

Cutting drug courts and reentry programs that rehabilitate offenders also presents a no-win solution. These interventions are in the best interest of public safety, because they decrease the odds of reoffending. In our five-year study of drug courts, we found that those who participated had lower relapse rates and committed fewer additional crimes—all types of crimes—than those who didn’t.

We also know that high-quality reentry programs can be critical for the success of returning prisoners, and this body of knowledge is growing. Programs that effectively prepare them for employment, offer education and vocational training, and provide stable housing help reduce the likelihood that they will reoffend. If we can lower their odds of committing another crime, then we help prevent others from becoming crime victims.

As the research shows, programs that address both victims’ and offenders’ needs benefit society as a whole, and cutting one at the expense of another leaves whole populations vulnerable.  We know that justice can and should hold offenders accountable, while implementing practices that prevent further crime. And justice can and should restore victims’ well-being and mend the breach in the social contract that the crime imposed. Justice for victims, justice for offenders, or public safety for all?  Why should we have to choose?

Photo: A California domestic violence shelter, which provided beds for 12, at a cost of $60,000 a year, was closed June 30, when it lost state funding due to the failure of the Gov. Arnold Schwarzenegger and Lawmakers to reach a budget. (AP Photo/Rich Pedroncelli)

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How being poor in DC makes kids’ asthma worse

Author: Nicole Levins

| Posted: April 16th, 2014




In the United States, more than 7 million children suffer from asthma. But in spite of the chronic and sometimes life-threatening nature of the disease, most of these kids lead active, healthy lives.

That’s not the case for some low-income families in Washington, DC. Asthma’s a big problem for the relatively small city, where the proportion of children suffering from the condition is one of the greatest in the nation.

Fortunately, DC is also home to IMPACT DC, an emergency department-based intervention that has helped reduce the number of emergency room visits from low-income children with asthma. But despite the program’s effectiveness, lots of DC kids and caregivers are still struggling to manage the disease.

So, how can we help everyone breathe a little easier? Urban Institute researchers, led by Marla McDaniel, teamed up with IMPACT DC to interview 33 players involved in asthma treatment—from parents to primary care physicians to IMPACT DC’s educators—to figure out why it’s so hard to treat asthma among DC’s poorest kids. In their own words, here are five potential factors.

Limited time

Low-income caregivers are often forced to balance parenting duties with inflexible jobs and non-standard working hours. Though children’s medical needs come first, it’s sometimes at the expense of the job that helps pay for the treatment.

“…I had to quit jobs before because she had an asthma attack three days in a row… They won’t let me take time off, so I quit.” - Caregiver

For educators and health care professionals, limited time with patients and caregivers makes it difficult to address all concerns and answer all questions.

“…Time is a huge factor... In most primary care visits, you have 15 minutes to cover the entire health of the child… the amount of time physicians have for health education is almost none...” - Asthma educator

Lack of management

Who’s in charge of managing a child’s asthma treatment? For children with multiple caregivers, there’s often no one person ensuring that the child sticks to the treatment plan.

“[Having] multiple caregivers is a strong indicator of poor adherence, for obvious reasons. Usually only one caregiver comes [to] the visit, and frequently it’s the caregiver with the most time on their hands...  But it’s not necessarily the one with the most power in the family dynamic...” - Asthma educator

Sometimes, the responsibility is left up to the child.

“When I am at work then she call[s] me. 'Mommy, it’s time for medicine,’ and I say, ‘OK, go do your thing.’ She turns it on and uses it… She knows what she[‘s] doing… But my son, I can’t trust him with nothing! He’s only four.” - Caregiver

Difficulty accessing care

In DC, the best doctors and specialists are often out of reach for those with low-incomes—located in the less transit-oriented suburbs and Northwest.

“[For low-income families in poor neighborhoods,] getting to the doctor is harder. Once you get to the doctor, you wait longer, so you’re less likely to go… And you lose an entire day of work.  And these are the families who also tend to have the least flexible work schedules.” - Asthma educator

“Unhealthy” housing

Cheaper, older apartments—where many low-income DC families live—can host a number of asthma triggers.

“We don’t have a thermostat to control the heat in the basement apartment.  It gets so hot in there and we have to keep the windows open all the time.” - Caregiver

“We had to move because there was something in the carpets [that was triggering asthma attacks]…” - Caregiver

Lack of adequate health coverage

Most doctors agree that Medicaid and other insurers could do a better job covering routine care for low-income patients, which could go a long way in preventing attacks and hospital visits.

“…Not all of the payers are allowing kids to have two inhalers at the same time. We have one for home, one for at school, and they don’t pay for both…” - Primary care physician

“One of the things [Medicaid] could do better is managing claims and hiring educators to look at claims to see who is filling what prescriptions and when and how often. They could then work with those families when they see prescriptions are not being filled.” - Primary care physician

“It’s much more cost-effective for insurance to keep [a] child out of the ER. There’s a lot of benefit for the insurance.” - Primary care physician

Photo from Shutterstock.

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How to improve services for crime victims

Author: Janine Zweig and Jennifer Yahner

| Posted: April 9th, 2014

It’s National Crime Victims’ Rights Week, and communities around the country are holding events to honor and promote the rights of crime victims. As researchers, we know that victim services can be critical to meeting the unique needs of those who have been violated.

Crime victims may not always realize it, but they are entitled to assistance when they begin the process of recovery. As they try to move forward, victims can draw support from a number of services, including safety and crisis intervention, individual advocacy to meet the variety of victims’ needs and case management, emotional support, legal advocacy, child advocacy, and even financial compensation.

But the evidence shows that a majority of crime victims do not receive such assistance. From 1993 to 2009, fewer than 1 in 10 victims of serious violent crime—including rape, sexual assault, robbery, and aggravated assault—received assistance from a victim services agency. Victims of less serious crimes, including simple assault and property crime, were even less likely to seek services.

Whether a victim reports the crime to police can be a key factor in getting services. From 2000 to 2009, a larger portion of violent crime victims who reported the crime to law enforcement received victim services (14 percent) than did those who did not report the crime (4 percent).

Although many victims don’t access services, the support is out there. In fact, crime victim services have grown exponentially in the past 30 years, with nearly every city in the country now offering some type of assistance, and numerous victim resource centers available by phone and online.

Research on the effectiveness of crime victim services is still in its infancy, but a major new effort sponsored by the federal Office for Victims of Crime is focused on narrowing the divide between research and practice. Bridging the Gap: Integrating Crime Victim Services Research and Practice is an effort led by the National Center for Victims of Crime, in partnership with the Urban Institute and the Justice Research and Statistics Association. This multifaceted project involves a comprehensive review of past efforts to bridge the gap, nationwide surveys of researchers and practitioners, and case studies of the most promising strategies for integrating crime victim services and research.

As researchers, we share a common goal with those who work on the ground in victim services: to help crime victims recover and move on with their lives to the best of their abilities. But we recognize that our approach is more scientific—focusing on which services have the greatest effect for the greatest number. Practitioners emphasize crime victims as unique individuals, and focus on delivery of what they know works best based on years in the field.

Both approaches are valid and critical to progress, but until researchers and practitioners work more cohesively, the gap between victim services and research will continue to limit our nation’s response to crime victims.

With the Bridging the Gap project and other recent efforts like the Researcher-Practitioner Partnerships Study, we are moving toward a more unified approach. By joining forces and sharing our collective knowledge, we get closer to the day when every crime victim receives appropriate services to meet their needs, no matter the circumstances.

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Tearing down barriers to success for young men of color

Author: Nancy La Vigne

| Posted: February 27th, 2014




People of color – especially young men – face many institutional hurdles to reaching their full potential. Chief among these is the expansive net of the criminal justice system— a net that is more likely to ensnare black and brown men at every step in the process. They are more likely to be stopped and frisked, to have their cars searched during traffic stops, and, when convicted of a crime, to receive longer prison sentences than whites.

This disproportionate contact with the criminal justice system compounds the many other systemic barriers young men of color often face, like living in high-poverty neighborhoods with poor schools, more crime, and fewer job opportunities.

That’s why I’m so pleased that the Obama administration’s upcoming initiative to support young men of color as they surmount these barriers includes mention of the criminal justice system. The announcement also includes two other key points: Data will drive the identification and establishment of best practices, and it will focus on “key moments in the lives of these young men where interventions have been shown to have the greatest impact.”

Some of these key moments occur early in young men’s lives, as they first encounter the criminal justice system in the form of police officers on the street, in their schools, and in their homes.

Roughly 30 percent of incarcerated parents report that their minor children were present at the time of their arrest. Boys who witness arrests that are violent, disrespectful, or involve foul language or physical violence are unlikely to view cops as the good guys. The manner in which police interact with children of the arrested – as well as with the arrested parents themselves – has particularly important implications for future community relationships. If handled inappropriately, the community could begin to view the police as an oppressive force in the neighborhood, undermining law enforcement’s legitimacy.

Yet most law enforcement agencies offer little guidance on an officer’s role in ensuring the safety of a child whose custodial parent has been arrested, and few uniform policies exist to guide law enforcement in attending to the arrestee’s children or determining where these children will be placed.

Negative perceptions of the police are further aggravated in cities that use intensive “stop and frisk” practices in high-crime areas. These tactics disproportionately target people of color, often arresting them for low-level drug possession that would otherwise go unnoticed, and further erode relationships between police officers and the communities they serve. In other words, a widespread crime-fighting tactic is teaching young men of color to distrust the criminal justice system while pulling them disproportionately into it.

This, then, is a key moment of intervention.  How could we do better? Evidence points to one of the basic tenets of community policing, which is to enlist the community as equal partners in public safety. Doing so demands interacting with residents respectfully and justifiably. When citizens feel like the police are treating them with respect, they are more likely to judge their treatment as fair, whether they’re arrested or released.

Other key moments in the lives of young men of color occur within public schools, where increased use of zero tolerance policies, enhanced police presence of school resource officers post-9/11, and rising rates of suspensions can eventually channel boys into the juvenile justice system.

These three ways the criminal justice system can restrain the advancement of young men of color also  also offer critical opportunities for tearing down barriers to life success. We already know so much about best practices, and encouraging rigorous evaluation and implementation will help us continue to find new solutions. Doing so can dramatically improve young men’s life chances by reducing the odds of negative encounters with the criminal justice system.

In this Wednesday, June 20, 2012 file photo, Det. Anthony Mannuzza, left, and Police Officer Robert Martin, right, simulate a street stop during a training session at the New York Police Department's training facility in Rodman's Neck, in the Queens borough of New York, as the NYPD was re-training thousands of officers on how to do street stops amid a wave of criticism about the department’s controversial stop, question and frisk policy. In the ongoing federal trial over stop and frisk, lawyers for men who have sued police are seeking to show a disproportionate number of black and Hispanic men are being wrongly stopped in part because officers are under too much pressure to keep enforcement numbers up. (AP Photo/Colleen Long, File)

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It's time to separate race and US firearm policy

Author: John Roman

| Posted: February 18th, 2014



Cory Strolla, Michael Dunn

It’s time to separate race and US firearms policy.

Racial disparities exist throughout the American judicial system. As I’ve written before, African Americans are more likely than white Americans to be stopped and frisked, to have their car searched at a traffic stop, to be arrested and convicted on a drug offense (even though they are less likely to consume illegal drugs—see Figure 18), and to receive the death penalty.

But it wasn’t until the shooting of Trayvon Martin and George Zimmerman’s subsequent trial that another huge racial disparity became evident. African Americans who kill a white victim are ten times less likely to be deemed justified in killing than whites who kill a black victim. The recent trial of Michael Dunn, who was charged with the murder of Jordan Davis, pushed the issue back in the spotlight.

That disparity is not proof that there is racial animus in criminal justice system case processing. But potential sources of any disparity need to be examined empirically, and the magnitude of this disparity is so large that it warrants particular attention.

It’s pure speculation on my part, but I believe that most Americans would be appalled by this apparent injustice and seek remedies if the issue was not so clouded by disputes around the Second Amendment. Those who favor gun rights want to see gun ownership protected, which might make them more open to a narrative where the victims of these crimes deserved their fate. Those who favor gun control might be more open to a narrative where the dead are victims only.

But if we were to separate the Second Amendment issues from the racial disparity question, we would ask a different set of questions. We would ask what differentiates homicides with a black shooter and a white victim from those with a white shooter and black victim.

The Federal Bureau of Investigation (FBI) requires local law enforcement to submit data on homicides, which are available to the public through the Supplementary Homicide Reports. These data describe each event, whether the victim and offender knew each other, what kind of weapon was used, whether either was law enforcement, and whether the homicide was ruled to be justified.

But what’s lacking in these data is the context of the killing. We know that homicides with a black perpetrator and a white victim are more likely to be robberies or burglaries that go sideways and end up in death—we just don’t know how often this happens. Are robberies gone bad 10 times more likely with a black assailant? We don’t know. But we need to find out to understand this disparity.

The flip side is that we also do not know much about white-on-black killings. We know that between 2005 and 2009, there were about 80,000 homicides in the United States. Since we don’t know who the killer was in about 40 percent of murders, we only know all the facts of the case in a little less than 50,000 homicides.

But, out of just under 50,000 homicides, an older white man killed a younger black man with a gun when they were strangers and neither was law enforcement only 23 times. Dunn and Zimmerman thus participated in extremely rare events. Neither was convicted, which was the outcome of nine of the 23 cases with that fact pattern (39 percent). By contrast, when a black American kills a white American, it is ruled to be justified about 1 percent of the time.

This issue deserves much greater examination, and it would be relatively easy to study. What’s missing from the FBI data is the context of the crime—in particular, whether it occurred on a street or in a home. If there is less than a tenfold difference in where these crimes occur, that suggests the disparity is unwarranted.

The problem is, we are having two debates simultaneously. We are debating the meaning of the Second Amendment at the same time we are grappling with racial disparities in the most serious of crimes.

If we can divorce race and firearms, we can talk about racial disparities in America and figure out if we need to create a more just system.

And then we can talk about the Second Amendment.

Assistant State Attorney Erin Wolfson, left, points at the defendant Michael Dunn, far right, as he speaks to his attorney, Cory Strolla, second from right, during the state's closing arguments in Dunn's trial, Wednesday, Feb. 12, 2014, in Jacksonville, Fla. Dunn is charged with fatally shooting 17-year-old Jordan Davis after an argument over loud music outside a Jacksonville convenient store in 2012. (AP Photo/The Florida Times-Union, Bob Mack, Pool)

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Can we have affordable health insurance without disrupting already-covered Americans? Not really.

Author: Judy Feder

| Posted: February 18th, 2014




Critics of the Affordable Care Act (ACA) want it both ways. They decry its disruption of health insurance coverage for those who have it, while asserting they too want Americans to have affordable coverage without regard to pre-existing conditions.

But we can’t have health reform without disrupting somebody. A good look at the ACA relative to alternatives demonstrates how modest – and helpful – its disruption really is.

In my latest brief, I explore how the ACA threaded the needle to minimize disruption of the already-covered, placing it in historical context and comparing it to reform alternatives.

The brief covers:

  • Why disruption is inevitable and how careful ACA designers were to minimize it;
  • How the ACA leaves employer-sponsored insurance (ESI) fundamentally unchanged for the 100 million people covered by large employers;
  • How the ACA targets its reforms to make broken insurance markets work for small businesses and individuals.

Yet even modest disruption encourages the belief that “there’s got to be a better way” to make insurance available, adequate, and affordable. So read on to consider:

  • How comprehensive alternatives to the ACA, coming from the left or right, would disrupt all or most of the 170 million people who rely on ESI and
  • How even modest measures touted as alternatives to the ACA’s market regulation would disrupt existing coverage that spreads health care risks.

No one likes disruption, but, relative to alternatives, the ACA’s disruption is modest in scope, cushioned by subsidies, and will benefit all participants over time.

Doctor's office lobby image from Shutterstock

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The employer mandate delay will have little effect on Obamacare

Author: Linda J. Blumberg and John Holahan and Judy Feder

| Posted: February 11th, 2014




The Obama administration yesterday announced further delays in the so-called “employer-mandate.” This provision of the Affordable Care Act would assess penalties on large employers not providing adequate, affordable insurance coverage to their workers if any of their full-time employees obtained subsidized coverage through a Marketplace. Some political controversy surrounded last summer’s first employer mandate delay, but, as we wrote then, such a move is unlikely to have much impact on the implementation of Obamacare.

In fact, the penalties  are neither a driving force behind expanding coverage nor an important source of federal revenue. This excerpt is from our July post:

As we have explained elsewhere, there is very little in the ACA that changes the incentives facing employers that already offer coverage to their workers, and fully 96 percent of employers with 50 or more workers already offer coverage today. Competition for labor, the fact that most employees get greater value from the tax exclusion for employer sponsored insurance than they would from exchange-based subsidies, and the introduction of a requirement for individuals to obtain coverage or pay a penalty themselves, are the major factors that will keep the lion’s share of employers continuing to do just what they do today with no requirements in place to do so.

Lessons from the Massachusetts health reform experience are instructive here as well. The Massachusetts law has substantially lower penalties for non-offering employers than does the ACA – the Massachusetts Fair Share Requirement is a maximum of $295 per worker, compared to a potential ACA maximum of $2,000 per worker. However, nominal as those assessments are, employer-sponsored insurance actually increased post-reform, as our analyses done prior to implementation predicted. This increase in employer based coverage was the consequence of individuals facing a new requirement to obtain insurance coverage and deciding their preferred source of coverage if they had to get it was their employer.

Throughout the development and the implementation of the ACA, there has been more worry than warranted that employers will drop insurance coverage. The current furor over the delay of the employer penalties appears to be more of the same. With or without the penalties, most people will still get coverage through their employers; the fundamental structure of the law will remain intact.

Office picture from Shutterstock

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State of the Prisons: a call for evidence-based reform

Author: Nancy La Vigne

| Posted: January 23rd, 2014

As President Obama prepares his State of the Union address, he’d do well to devote attention to our highly troubled state and federal prison systems. Our incarcerated population has grown rapidly, recidivism rates are high, and the costs to taxpayers are unsustainable.

The good news is that a large and growing body of research provides clear and actionable data on both the problems and their tried-and-true solutions.

The prison system and public safety

For decades, we’ve incarcerated people at alarmingly high rates. Until just recently, the growth rate of the prison population has been equally disturbing, with the latest tally of people housed in state and federal prisons coming in at about 1.5 million*.


The exponential growth of the federal prison population poses safety risks for prisoners and staff alike. What’s more, it limits access to services like education and drug-treatment programs that are critical to preventing recidivism—making overcrowding a danger to us all.

These risks come with a great financial burden. The federal Bureau of Prisons’ budget for FY 2014 is $6.9 billion, a quarter of the DOJ’s entire budget. Without meaningful reforms, that share will grow to a third within the decade. Such massive correctional spending comes at a huge cost to other important public safety investments.

Can we reverse the tide?

Despite these obstacles, there is reason for optimism. Several states have already made meaningful reforms to their state prison systems by funding smart, research-backed public safety strategies that reduce incarceration rates and save money. Similar strategies can work throughout the prison system.

Other research has also shown us how important it is to support former prisoners with tailored supervision and services as they reenter society. This support sets them up for success by connecting them to positive social networks and employment. Without these, they are far more likely to reoffend.

So, what can we do to prevent our prisons from further overcrowding?

Policy options

Research indicates that a host of reforms will be needed to reduce the growth of the federal prison system, such as:

  • Reducing or eliminating mandatory minimum drug sentences
  • Giving judges discretion in the application of mandatory minimums
  • Lowering the minimum share of a sentence an offender is required to serve

There are also key lessons to be learned from the states, as we document in our soon-to-be released report on the groundbreaking Justice Reinvestment Initiative. For example:

  • How proven risk-assessment tools can help courts and judges evaluate the likelihood of recidivism.
  • Why some offenders may be far better served with community- rather than prison-based treatment programs, saving taxpayers money.
  • How reducing sentence lengths, streamlining parole systems, and expanding eligibility can also reduce prison times and cut spending on unnecessary incarceration.

These and other strategies benefit prisoners who fall at the mercy of harsh sentences and long prison terms. Creative solutions like these help people stay out of prison and save taxpayers money.

It’s time to invest in these reforms, for the millions of Americans in our prison system—as well as for those who aren’t.

Follow Nancy La Vigne on Twitter at @NLVigne

*This post has been corrected from a previous version to reflect that there are 1.5 million state and federal prisoners, not 7 million. Our apologies.

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