felini draft may 2010
TRANSCRIPT
Dallas Police Department’s
Prostitute Diversion
Initiative
“The key to unlocking a new life”
Sgt. Louis Felini,
Dallas Police Department
Dallas, TX
17th Annual Texas
HIV/STD Conference
May 27, 2010
Presentation Outline
• Impetus for developing a prostitution
diversion program in Dallas, TX
• Demonstrate the need for a new approach to
the problem of prostitution
• Overview of PDI program
• A look at the data
September 11, 2001
changed the way we looked at truck
stops…..
…the ‘what if’ scenario
• Response
• Magnitude of Problem
• Economic Nightmare
Problem Identified
• Inadequacy of conventional approach to address changing dynamics of truck stops and address both local and national concerns
Prostitution
Robbery
Fraudulent
documents
Drug
traffickingHuman
traffickingTheft
ASSAULTS
HOMICIDES
Back to the
drawing board
Collaboration
Mission
• Offer concrete long-term services for
victims of sex industry and options for
exit
….while this mission is similar to other diversion
programs, the PDI is unique in that it:
• Law enforcement led
• Brings services to the streets
• Provides long-term intelligence strategy
DPD
Mobile Command Post
Dallas
County
Health
Dept.
Sheriff’s Department
Mobile Command Post/Community Court
DPD
Vice
Mobile
Command
Post
12
3
4
TRIAGE
Lancaster Blvd.
Cherry Valley Street
Interstate 20
PDI: Schematic Representation of Site
5
Services Provided On-Site
• STD screening and presumptive treatment
• ID Program
• Food and Clothing
• Advocacy
Continuation of Services in
Treatment – New Life
• Shelter and food
• Medical and mental health treatment
• Child care
• Job skills training
• Out-patient counseling for lifetime
• Opportunity for resolution of pending legal issues
upon completion of program
Impact on Crime in Beats
where Truck Stops Located
I-40 Deaths Investigation
OK, AR, MS, TX
Margaret
Gardner
Sandra
Richardson
Casey
PipestemPatsy
Leonard
Unidentified Jennifer
HymanSandra
Beard
High Risk Potential Victims
DNA Database
• Highway Serial Killers
• FBI’s ViCAP Unit, Dallas County
Sheriff’s Office, and Dallas Police
Department
• University of North Texas Health Science
Center’s DNA Forensics Laboratory
Vision of long term return
• Development of informants
• Post-mortem identification of prostitutes
• Serve as model for other cities
• Prostitute Solicitation School
• Salvation Army Support Group
• PDI/New Life 501c3
• Resume’ Building (Thistle Farms Program)
DESCRIPTIVE ANALYSIS
Martha Felini, PhD DC MPH
UNTHSC Epidemiology, SPH
Fort Worth, TX
Team Effort
• Gabriela Cantu, MPH
• Lindsey Brown, MPH
• Gloria Mendoza, MD MPH
• Amy Abraham
• Raquel Hampton, PhD
• UNTHSC, Center for Community Health, and
PACE
Objectives
1) To describe basic characteristics and health
status of sex workers contacted by the PDI
program
2) To assess the efficacy of the PDI
Background
• Diversion programs becoming more popular
• Limited resources
• Over 500 diversion programs in US
• Majority are post-booking diversion
• PDI – pre-booking diversion
• No known data on truck-stop prostitutes
• Unknown base population
• Migratory
Background(Potterat et al. 2004)
• Mortality rates 200x that of women of
similar age and race
• 18 times more likely to be murdered
• Nearly half have attempted suicide
Effects of Prostitution
• Individual
• Family
• Societal
• Public Health
Services needed to exit
prostitution, (Farley, 1998)
• Safe place/home
• Job training
• Health care
• Individual counseling
• Peer support
• Legal assistance
• Drug and alcohol treatment
• Self-defense training
• Childcare
• Physical protection from pimp
Study Design & Analysis
• Cross-sectional study -- convenience sample
• Eligibility criteria: Adult sex workers
contacted throughout Dallas the first
Wednesday of each month
• Descriptive statistics: univariate and bivariate
analysis
PDI: Preliminary Evaluation
(October 2007- May 2010)
• 491 contacted on the streets
• Majority by arrest / 27 walk ups
• 1 juvenile, 3 pimps excluded= 487
• 54 repeaters
• 246 eligible for immediate diversion
• 50% opted for treatment
Demographic characteristics of
prostitutes contacted (n=487)
o African-American (75%),
o Female (97%),
o Late 30’s (average: 37, range: 17-63 ),
o Caretaker (59%)*
o High school education or higher (53%)*
*among 370 participants
Self-reported health conditions
Physical health conditions
o Asthma
o High Blood Pressure
o Seizures
o Others: cancer, anemia, hepatitis, lupus,
arthritis, cirrhosis, COPD
Distribution of self-reported
mental health conditions
Mental health conditions
54% self-reported having a mental condition
Nearly 2/3 of these reported having more than one
* Data do not reflect mutually exclusive persons
Condition reported Proportion (n=370)
Suicide Attempt 20%
Bipolar Disorder 30%
Schizophrenia 16%
Major Depression 31%
Proportion of Drug Use
0%
20%
40%
60%
80%
Statistics only include 370 participants and are not mutually exclusive
Diagnostic AssessmentAmerican Psychological Association DSM criteria
• Axis I = 84%• Details mental health and substance abuse disorders
• Axis III = 37%• Details medical conditions
• Axis V = 66%• Global assessment of functioning
32% assessed with three axis
34% assessed with two axis
26% assessed with one axis
8% no axis designated
* Data do not reflect mutually exclusive persons
Disposition
0 100 200 300 400 500
Eligible Ineligible
Entered
treatment
(n=122)
Opted to not
enter treatment
(n=124)
Jail
(n=211)
Opportunity
to enter
program in
pre-trial
releaseNOTE: 3 ineligibles missing
Tx
(n=21)
Participant Success
• 25% of participants completed initial
treatment program
• 65% completing initial treatment program
remain abstinent and in supportive services
with no subsequent re-arrests in Dallas
County
Limitations
• Defining success
• Data quality
• Convenience sample
• Heterogeneity of prostitute population
What the data teaches us
• Prevalent substance abuse (95%) is self-medication
to co-exist with multiple mental health conditions
and cope with risky behaviors
• Feasibility of community organizations partnering
with law enforcement agencies to bring needed
resources directly to the streets where vulnerable
populations often experience barriers to care
STD DATA
Marisa Gonzales
STD Operations Manager
Dallas County Health and Human Services,
Dallas, TX
South China
11% (n=362)
China
14% (n=966)
Germany
9% (n=561)
Spain
3% (n=66)
Congo
16% (n=502)
Indonesia
8% (n=200)
New Guinea
32% (n=407)
Senegal
29% (n=274)
Dallas, TX
30% (n=423)
Summary of studies: Proportion of
prostitutes testing positive for syphilis
Thank you
www.pdinewlife.org
Contact information
Sgt. Louis Felini: [email protected]
Dr. Martha Felini: [email protected]
Marisa Gonzales: [email protected]