Replicating an Integrated Care Model for Justice System-Involved Youth

Grantee Name

Center for Alternative Sentencing and Employment Services, Inc. (CASES)

Funding Area

Special Projects Fund

Publication Date

February 2026

Grant Amount

$150,000

Grant Date:

2022

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Individuals with mental illness and substance use disorder are disproportionately represented in the criminal legal system and often encounter barriers to behavioral and primary care services after returning to their communities. Delays in care can trigger a cascade of devastating events, including uncontrolled chronic illnesses and mental health crises. In 2014, the Center for Alternative Sentencing and Employment Services (CASES) opened the Nathaniel Clinic in Central Harlem, with State and NYHealth support, to help individuals with mental illness impacted by the criminal legal system. The Nathaniel Clinic is one of only two licensed outpatient mental health clinics in New York City. The clinic offers integrated services for mental health, primary care, substance use, peer and case management, and mobile crisis outreach in one central location. The demand for services is high, and individuals travel long distances for care. As of 2021, one-quarter of patients traveled from the Bronx, a borough with disproportionately high rates of incarceration, chronic illness, and hospitalization, to the Central Harlem site.

In 2022, NYHealth awarded the Center for Alternative Sentencing and Employment Services a grant to replicate the integrated care model in the South Bronx and provide primary care services for people with mental health disorders, ages 13 and older, involved in the criminal justice system.

Outcomes and Lessons Learned

Outcomes and Lessons Learned

CASES expanded its electronic health records system to capture the full scope of satellite services and developed a real-time dashboard to track referrals, admissions, engagement, and service delivery. These tools improved management oversight and positioned the clinic during the start-up phase.
State-funded renovations and persistent workforce shortages—particularly in the nursing profession—delayed the service rollout. These challenges limited early progress toward several proposed benchmarks, including timely health evaluations and group wellness programming.
Once staffing stabilized, service growth accelerated meaningfully. Since July 2024, the Bronx location has maintained a 100% staff fill rate. In the first quarter of FY2025, the clinic served 90 clients and delivered 527 services—reaching more clients in three months than its total FY2024 client reach. Monthly service volume increased nearly 50% between July and September 2024.
Approximately 60% of active clients are now connected to regular primary care services. Seventy-six percent of clients with behavioral health needs were successfully connected to primary care for chronic disease management. While short of the project’s universal monitoring goal, this represents meaningful progress for a newly launched clinic serving a complex population.

Low Medicaid reimbursement for Licensed Practical Nurse (LPN) services made recruitment and retention difficult and rendered the early phase of implementation financially vulnerable. NYHealth’s grant played a critical risk-absorbing role in the startup of integrated primary care within a Medicaid-reliant, criminal legal system specialist clinic—an environment where workforce shortages, low reimbursement rates, and operational complexity routinely delay or derail implementation. As the services continue to grow, CASES’ integrated behavioral health and primary care model continues to expand, sustained through a combination of public and private grants and increased Medicaid reimbursement.

Co-Funding and Additional Funds Leveraged: US Substance Abuse and Mental Health Services Administration (SAMHSA) ($3,000,000), ongoing Medicaid reimbursement revenue

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