refighters and peace officers that were composed of multiple occupations. We used data from the Occupational Information Network (O*Net) survey administered by the US DOL to rank occupations based on their similarity to firefighters and peace officer


loyers, including th ose at the local-government level who employ most first
responders in California. A relat ed missing-data problem is tha t many claims with a FROI do not
have any medical bills in the WCIS, while many medical bills in  earlier


Similar limitations rule out the Medical Expenditures
Panel Survey Household Component , which also captures diagnosis  codes but includes only very
coarse occupation categorie s on the public-use files.
The K6 was not designed to measur e PTSD, s


mitations to the WC IS analysis as well—most notably  that we can ascertain the
presence of PTSD or other medical conditions only when workers seek care for those conditions
in the workers’ compensation system. Our case-ascertainment app roach incl


nd show the
prevalence estimates of suici dal ideation by occupation. This i nformation answers research
questions 1 and 2:
 RQ1: Do firefighters and peace officers have a higher incidence of  traumatic stress
injuries than non-public employees


name PTSD to PTSI, to address the perceived stigma of having
this diagnosis and help diminish barriers to care. The rational e for this change was that the “D” (for “disorder”) in
PTSD is believed to increase stigma and discourage treatment-se ekin


chs, and Ehlert, 1998). 32 A number of studies have documented rates of PTSD among firefig hters after sentinel events,
such as terrorist attacks or othe r mass casualty events Berning er et al. (2010a, 2010b) reported an
elevated prevalence of PTS


d peace officers has not
uniformly found elevated suicid e rates, however. Findings on oc cupation-specific suicide rates
vary, in part because studies have used different methods and estimated different quantities.
Broadly speaking, epidemiologis


pations  27.4 [26.9, 27.9] 7.7 [7.5, 8.0] NOTES: Adapted from Peterson et al. (2020). a Statistically higher than the population rate (all industries or occupations) based on 95-percent confidence interval (CI) of the industry or occupational group r


t an
elevated risk of suicide compared with other male workers. Howe ver, the worrisome finding that
women in protective service occu pations do have an elevated sui cide rate calls for further
research to examine whether those rates among peace o


 to “perceived”
stigma, or a fear of ostracism. F indings from the National Como rbidity Survey (NCS) suggest
that individuals with PTSD ma y not seek treatment largely becau se they do not perceive a need
for services. For example, ove r 60 perce


ers, it was common to witness a shooting incid ent; some reported also
seeing accidents caused by driving u nder the influence, plane c rashes, mass-murder incidents,
and lethal-force encounters. Fir efighters described exposure to a variety of tra


neys noted tha t first responders often respond ed to multiple traumatic
incidents, especially shootings or other violent events. Being involved in incidents where there
was violence toward the first r esponder was most common among p olice officer


 go ing to bed  . . . . It is compounded by
sleep deprivation because you have to respond to calls [on the job]. This leads to heightened
anxiety and awareness. Every 911 call, it is like adding a file  to your rolodex. We are constantly
in scenar


alth provider who treats firefighters (FS-MH02)  39 In short, our interviews confirmed previous research findings that both firef ighters and
peace officers are frequently expos ed to traumatic events; the nature of their work also makes
cumulativ


lifornia
workforce are immediately appa rent. While 46 percent of all wor kers in California are female,
only 15 percent of first responders  are female. First responder s are also younger than the average
worker in California, with somewhat fewer


. NH/PI = Native Hawaiian/Pacific Islander. 42 composition of first responders also differs from the overall C alifornia workforce, with higher
proportions of White Non-Hispanics and Black Non-Hispanics and lower proportions of
Hispanics and Asian


 h insurance, compared with
91 percent of comparison occupa tions and 80 percent of security  guards. Peace officers are more
likely to be White Non-Hispanic ( 53 percent) than those in thei r comparison group (48 percent),
security guards (23 pe


evalence of serious mental di stress (1.2 percent) than their comparison group (2.3 percent) or
ambulance drivers and EMTs (4.1 percent). Peace officers, similarly, have a lower estimated
prevalence of serious mental distress than their comparison


 evalence of suicidality—measu red primarily as any lifetime
history of suicidal ideation—by o ccupation. First responders ar e less likely (4.3 percent) than
those in comparison occupations (9.5 percent) to ever have experienced suicida l ideation


Firefighters and
Comparison Groups Peace Officers and Comparison Groups All
Workers
Occupation First
Responders  First
Responder
Comparators Firefighters Firefighter
Comparators Ambulance
Drivers and
EMTs Peace
Officers Peace Officer
Comp


mortality rates among firefighters and peac e officers or by higher suicide mortality rates among
other protective service occupations with substantial female employment. Estimat es from household survey data that
are representative of California s


 worriso me limitation is that first
responder suicides are known to be differentially underreported  (compared with other
occupations). This underreportin g has been attributed to corone rs and medical examiners
misrepresenting the cause of dea t


ra wing on a review of the rules and
regulations pertaining to workers’ compensation claims filing, we look at the mechanics and
timelines involved in filing and pr ocessing mental health claim s within the larger workers’
compensation system. We


tus (see
Figure 4.1).
Figure 4.1. Workers’ Compensation Claims Process

SOURCE: Based on California Depart ment of Industrial Relations,  2016.
Claims can be filed using a Divi sion of Workers’ Compensation ( DWC) DWC-1 form
(Department of Indu


 attorney who works to represent the worker, can appeal the decision to the
Workers’ Compensation Appeals Board (WCAB). The WCAB then makes  a final determination
on the claim. See Figure 4.2 for an overview of the multiple st eps embedded within t


ms administrator has up to
90 days after a claim is filed to either deny or accept it. We interviewed first responders and
applicants’ attorneys as well as  department stakeholders about their experiences with mental
health claims that are de lay


es about finances and work st atus, stigma related to having a
mental health claim, family stre ss, and family issues that could lead to divorce. As one
applicants’ atto rney commented,
The workers’ compensation system is so destructive to mental


 QME denied or disagreed with the mental health diagnosis
given on the claim or because the Q ME or claims administrator d enied its job-relatedness. This
viewpoint was more common among a pplicants’ attorneys who represented predominantly peace
o


r both fire and polic e departments. One police officer
stated,
These claims adjustors run a business, and part of their job an d strategy is to deny things. People
believe you are going to get denied. What happens if you get in to a fight with th


two
to 15 months and was roughly six months (median). This compared  with the three - to four-month
timeframe of filing to acceptance for the two mental health cla ims that were not denied. The first
responders interviewed had comp licated, drawn-


or prior mental health treatment (not
for the current injury) were  documented, that this was often us ed to prove that the current mental
health diagnosis was  not job-related. Appli cants’ attorneys did  raise issues of a lack of medical
mental


We also asked claims administra tors health professionals and ch iefs of departments whether
their experience was for mental health claims to be filed alone or combined with physical.
Primarily we heard from all thr ee groups that mental health c


ders to repor t true claims of mental health issues.
The majority of those departments were police departments. One claims administrator asserted,
If the claim is for police officers and firefighters, we do not  really need to prove anything
abou


fterwa rds that they cannot pay for
treatment . —Northern California mental health pr ovider who treats peace officers (PN-MH02)
Some mental health providers i ndicated that this directive came  from the department chiefs.
A mental health pr ovid


 the job (establishing job-relatedness)
and that the diagnosis provided w as appropriate. If mental heal th providers do not supply
sufficient documentation for a diagnosis, claims administrators  usually request that the injured
worker schedule a


erage, th ose who file workers’
compensation claims tend to be older and thus have an age distr ibution that is more comparable
with other occupations. Geographic differences across occupatio ns are also more muted among
workers who file workers’


ter
Comparators Ambulance
Drivers and
EMTs Peace
Officers Peace Officer
Comparators Security
Guards Correctional
Officers All
Workers
Demographics
% Female 13.8% 17.6% 5.4% 8.1% 36.0% 18.5% 32.8% 28.3% 26.7% 44 .0%
Mean Age 40.4


66 152, 965 30,819 37,910 2,930,923
NOTES: Authors’ calculations , 2008–2019 WCIS. Other Infectious Diseases = Lyme disease, meningitis, or tuberculosis. MRSA = Me thicillin-resistant Staphylococcus aureus.
Sample is limited to observations  for wh


en largely by
claims involving cancer, heart di sease, and, to a lesser extent , low back impairments and hernias.
For peace officers (22 percent of claims involving presumption conditions, compared with
18 percent for their comparison g roup, 17


termination basis,  though note that the WCIS does
not distinguish post-termination cla ims (a legal term of art fo r claims that are filed—sometimes
in bad faith—following an involunta ry job separation) from clai ms filed after job separation
f


9 WCIS. Sample is limited  to observations for which ther e are valid occupation codes; wo rkers’ compensation data is sourced from a
claims administrator who reports indemnity benefits on at least  15 percent of the total FROI subm issions and has


fferences in benefit rece ipt between claims filed with
TPAs and claims filed with self-ad ministered employers. In gene ral, TPAs appeared to be much
more likely to pay indemnity benefits than self-administered em ployers, which may suggest that


ministered Total Self-Insured,
TPA Self-Insured,
Self-
Administered Total Self-Insured,
TPA Self-Insured,
Self-
Administered Total
% Receiving Settled Indemnity Benefits
Narrow: PTSD 30.7% 3.0% 20.6% 29. 4% 0.0% 13.8% 31.0% 5.7% 24.0%


han the 20-percent rate estimated for the peace officer compar ison group and the 17-percent rate
estimated for security guards. Co rrectional officers had a claim denial rate (25 percent) that was
close to, and not statistically d ifferent from, t


ace officers). Denial rat es for other conditions covered by
presumptions were lower than for mental health conditions.
73 Table 4.9. Proportion of Claims Initially Denied (Any Final Disposition), by Involvement of PTSD,
Anxiety/Trauma Disorders,


injuries only. Remaining claims involving anxiety and trauma-related disorders were mostly filed as cumulative injuries not otherwise classified (13.5 percent of firefighter claims and 15 percent of peace officer claims), with a small number filed a


lving PTSD.
Throughout the workers’ compensation system, most claims (57 pe rcent) involving anxiety and
trauma disorders entered the system as physical-only claims. Cl aims from firefighters and peace
officers were less likely (51 percent each) t


iscusses the i ssues involved in proving the job-r elatedness of mental
health conditions listed on first responder claims. We first de scribe the perspectives of
mental health professionals rega rding the feasibility of provin g or disproving the


related
79 (i.e., that an injury arose out of employment or happened durin g the course of employment,
AOE/COE) and learned what elements are necessary to establish t hat job-relatedness.
All of the mental health profe ssionals we interviewed ind


 is a huge change in their be havior from before to when they
file the claim. If it is documen ted just like other injuries, previous mental health treatment is not a
problem. The main thing about pr oving job-relatedness is when t he person got tr


ts who were we ll into their careers, who
needed mental health treatment because of the cumulative stress  of exposure to trauma over time.
(See Chapter 6 for further disc ussion about the timing of menta l health treatment for first
responders.)


any mental health providers  that they themselves do not
always keep records with the deta ils needed for workers’ compen sation claim requests. Claims
administrators also said that re ports from mental health profes sionals were lacking, citing a


 firefighters (FN-MH01)
One mental health pr ovider pointed out the irony in the workers ’ compensation system that
childhood history is not an issue when it is a physical injury claim for a first responder. They
stated,
I see a lot of back and k


 with anymore. —Northern California mental health provider who treats peace officers (PN-MH10)
The experience of establishing the job-relatedness of mental he alth conditions was largely
similar among all of the mental  health professionals in this


e a mental
health provider who says the me ntal health claim is not work-re lated, but that is not that common.
With sufficient medical professional support from documentation , we usually pick it up and
accept the mental health claim. —Southern C


m
earlier. —Northern California claims admini strator for peace officers (PN-CA12)
Claims administrators also raise d the issue that firefighters a nd police officers alike need to
receive treatment from mental  health providers within the worke


ightmares, where it is hard to see if it is job-
related. Prior to 2020, police officers can be bringing somethi ng up from five to six years ago. So,
we have to look at the situation at that time when they were ge tting treatment. It is equally as


licants’ Attorneys
Applicants’ attorneys also ela borated on their experiences prov ing and disproving job-
relatedness and explained how things  may change within the cont ext of the SB 542 presumption.
Most applicants’ attorneys men tioned that,


nied. But now with the  presumption, it makes it easier
87 because I need to only  get medical reports. When there was not the presumption, then there was
much more to do and to substantiate with documentation. Without  the presumption, I have to


as
column totals in Table 5.1).
For firefighter claims involving P TSD, the denial rate is drama tically higher for TPA claims
(31 percent) than for those of self-administered employers (17 percent). Similar patterns are
observed for other presum


idence; record s were submitted by claims admin istrators who had reliable repo rting of SROI records  and had at least one
medical bill reported. Estimates  are weighted to be representat ive of all FROI filed with complet e records and with occupa


ally higher for claims
that are initially denied (25 percent of initially denied PTSD claims versus 20 percent of initially
accepted PTSD claims), while even starker differences are obser ved for settlements: while
20 percent of initially denied


oyers, which again stands in contrast to patterns of benefit receipt among other presumption claims filed by firefighters or other presumption claims filed by peace officers that are handled by TPAs. When we look at all claims filed by peace
officer


o make sure they get the be st care they can get and
continue to do the job for our city. Internally, it makes it a lot easier. —Northern California
claims administrator for firefighters (FN-CA01)
I think it makes a difference if a department is


y firefighters (or peace officers) that are subject to presumptions of compensability? NOTE: As part of the response to this question, the contractor should analyze the denial rates of claims subject to presumptions of compensability, whether denial


ecific traumatic exposures, cumulative exposure to traumatic events, or retraumatization. Rigorous preemployment psychological screening was cited as a reason why new-onset mental health conditions among first responders could be attributed to employ


 First, they indicated that workers’ compen sation claims need to define a
specific incident and to be file d within the year of the incide nt/injury. The fact that most first
responders are slow to seek car e and tend to “gut it out” also prolongs


 across claims administrators from depart ments with high and low denial
rates of mental health claims. Specifically, claims administrat ors for departments with low denial
rates indicated that first res ponder employment training and selection rul


TSD is not included there specifically. They indicated that in time, once there are more cases, these detail s will be clarified.
In response to research ques tion 3, we found from the WCIS data  that claims involving
mental health were much more l


e tried
to minimize the scope for bias due to data-quality differences by excluding from our sample of
WCIS data any data from claims administrators that report suspi ciously low volumes of
indemnity claims (a symptom of  unreliable SROI reporting


t doing so would create
such a perception, especially in the eyes of their peers or sup ervisors, that they were not able to
do their jobs. Many of these worke rs also noted that they were afraid of losing the ir jobs if they
sought mental health


ere they do not
let the powers that be know that they are seeking mental health  treatment on their own. Usually
when it relates to alcohol or drug use, the firefighter or poli ce officer want to keep it quiet out of
fear that their department wou


n do not provide follow- up care or resources in the
ensuing weeks, potentially m aking the problem worse.
In all departments interviewe d, workers had access to an EAP pr ogram that was typically
used as the first line of treatment for injured wo


ovider, and they told me to work out and e at healthy . . . I am never getting
that type of help again. You have to know if the person is comp etent with firefighters or police
officers. —Northern California firefighter (FN-FR01)
They had me conta


e intensive programs that required significa nt funds, typica lly provided by
the department, and time off of  work. A few departments belonged to a program that provided
first responders and their families access to mental health resources through


 ider who treats peace officers (PN-MH01)
Chiefs reported that their depa rtments had the necessary behavi oral health supports for their
first responders but said ther e was work yet to be done to addr ess the stigma associated with
104 accessin


re department until recently;
I’d say in about the last year. I know other people that are go ing now to see the mental health
provider on contract. Now we can talk about mental health and t he stress of our jobs. Nobody
talked about it before. It


ok for ou tward signs of stress. —Southern
California police chief (PS-DC01)
Recognition of Trauma Within Departments
Department chiefs discussed the a bility of their departments an d themselves to recognize
trauma in their first responders . N


 incident-
specific, the captains, fire chiefs, and other firefighters und erstand the differences in behavior of
their fellow firefighter to know how that has affected a particular firefighter. Or the firefighter
themselves can request that they s


s no downside. I learn
through incidents. —Southern California fire chief (FS-DC04)
Department representatives identified two major sources of stigma that kept first responders
from accessing and seeking care; namely, pride and fear of losi ng the


n California peace officer
(PS-FR11)
We as police officers don’t ask for  help; people ask us for help. Police officers are used to getting
asked for help. —Northern California peace officer (PN-FR03)
A firefighter expounded,
108 It is a sign


were veterans.
A third of the first responders ( split across firefighters and peace officers) had also used mental
health treatment in the past (un related to the claimed incident ). The PTSD-specific care provided
to the first responders we inte


be the r easons why respondents with unmet needs for mental health and
substance use care did not recei ve treatment. The CHIS allows r espondents to name one or more
of four specific reasons, whic h we grouped into two (non-exclusive) categories.


any peace officers
named cost as a barrier to receiving mental health and substanc e use treatment. We were also
surprised by the sharp contras t between the proportion of firef ighters and peace officers who
named stigma as a reason for not r ece


a physic al injury. Of those workers whose claims were denied, half
sought the needed mental health treatment before receiving the denial, and half started after. This
addresses research question 7 about  the timing of treatment and  denied claims.


health providers indicate d that on rare occasions, a first responder used employer-
sponsored health insurance for me ntal health treatment. This wa s possible only when an injured
worker did not yet have an accepted workers’ compensation claim , h


ere initially inve stigated. Given the difficulty with getting claims accepted and
the long delays between filing and getting a final adjudication, nearly all injured workers we
interviewed opted to pay for thei r mental health care through s elf-


ls for psychiatric care to
treat PTSD even after a claim wa s accepted. To e xplore whether claims for men tal health
conditions were more likely to be  denied than cla ims on other t ypes of injuries, we used
medical billing data to summarize bil


n Charges on Denied Bills as  % of Mean Charges, Mental Healt h
Diagnosis 14.0% 16.9% 12.6%
Mean Paid Amount at 24 Months, Ment al Health Diagnosis on Bills
(Intermediate Definition) $2,032 $2,418 $1,889
Mean Paid Amount as % of Mean Char ges, M


lving mental  health conditions frequently also
involve physical injuri es, which means not all the bills includ ed in the statistics reflect mental
health care. For this reason, T able 6.2 also reports charges, denials, and payments on bills with


out whether  others thought they could do th eir jobs, whether they would lose
their jobs, and whether others in the department (including the ir very close colleagues) would
view them negatively. Quantitat ive estimates show that about 12  percent


ces tended to
support first responders participa ting in intensive treatment, such as PTSD retreats, and provided
access to a confidential app for t reatment support (for first responders and their families). Most
first responders, however, said t


lth treatme nt than firefighters (although pea ce officers may have received
more intensive avenues of car e), delayed their care by not seek ing treatment right away, or
simply chose to “gut it out.”
Further, we heard that the worker s’ compensat


effect as well as the costs asso ciated with retroactive applica tion of the rules of SB 542. We
illustrate the possible degree of variability in the estimated costs, due to changes in assumptions
about the true incidence rate  of PTSD; the impact


irst responders. This dramatic cost difference needs to be
interpreted with caution, how ever, as we discuss below.
Table 7.1 indicates some other im portant facts about benefit co sts associated with claims
involving PTSD. Paid benefits are prima


rovide  more details on the costs associated with specific categories of
indemnity benefits in Table C.8.
Table 7.1 contains one last impor tant finding, which is that in itial claim denials are
associated with much lower amount s of paid benefits


hly prevalen t health conditions (including
cancer, heart disease, and back pa in). We saw in Chapter 4 that claims involving PTSD very
frequently involve multiple injuries or health conditions: the incremental cost of adding PTSD to
a workers’ co


 of Claims × Cost per Claim,
where
126 Number of Claims = Number of Fir st Responders × PTSD Incidence Rate × Probability of
Seeking Care for Those with P TSD × Probability of Filing a Work ers’ Compensation Claim for
Those Seeking Care,
and
C


al Government, BLS OES Estimates
Occupation and Level of Government 2020 Employment
Peace Officers
State 8,953
Local 68,897
Total (State + Local) 77,850
Firefighters
State 4,380
Local 29,550
Total (State + Local) 33,930
SOURCE: OES es


ncidence, treatment- seeking, and recovery estimates and generates annual
prevalence in each year. We then calculated the change in estim ated prevalence in each year . After ten years, the rate
of change dropped to zero, and t he resulting prevale


filing) that
would result from elimination or reduction of cost- and stigma-related barriers.
Workers’ Compensation Filing Scenarios
We considered three potential changes in how peace officers and  firefighters with PTSD
might file workers’ compe


initial denial rates of
claims for PTSD. Table 7.5 summarizes the denial rates for each  scenario. Scenario A assumes
that there will be no change in t he initial denial rates, so we  used the rates described above
(Chapter 4). Scenario B assumes


se incidents. However, they
might still seek reimbursement for PTSD care that was not cover ed by workers’ compensation at
the time.
131 Workers’ Compensation Claim Payment Estimates
As we describe in Chapter 4, there  are three components for w


because of differences in budget imp acts. We include estimates for
each of the filing scenarios described in Table 7.4: (1) all wh o would not seek care because of
stigma (peace officers) or access (firefighters) would seek car e and file workers’


ce
officers will file 5,715 workers’  compensation claims over the next five years (compared with 855
if there is no change in the f iling rate), and firefighters wil l file 1,385 (compared  with 410 if there
is no change in the filing rate). The


2 NA NA
High Incidence Rate
Peace Officers State All who seek carea $71,892,633 $75,418,333 $78,591,463
(5% Incidence Rate)  Elimination of barriersb $94,250,576 $99,010,271 $103,064,826
  Partial elimination of
barriersc $51,730,429 $54,19


ge costs of claims re porting mental health as the
nature of the injury at the time the claim was initially filed (Table 7.6). As discussed above, we
estimated costs using this subset of PTSD claims to examine whe ther the high costs of PTSD
claim


 benefits and settlements on first responders’ PTSD claims
totaled $63,049. In comparison, the average cost of paid benefi ts for all first responder workers’
compensation claims was $14,076. We note that other presumption  conditions, many of whic


6,131,214
Firefighters State Elimination of barriersa $3,169,496
(11.5% Incidence Rate)  Partial elimination of barriersb $1,995,821
  All who seek carec $16,613,523
 Local Elimination of barriersa $18,492,550
  Partial elimination of barriersb


nonfederal peace officers and 87 percent of nonfederal
firefighters in California. The range of  uncertainty is very large, however: Over the 2020–2024 period, plausible
assumptions about incidence rates and behavioral responses could result in ave


e yearly statewide
number of claims involving PTS D prior to SB 542 to be 80 firefi ghter claims and 168 peace
officer claims. Under an interme diate scenario—a scenario in wh ich the true PTSD incidence
rate among first responders is similar to t


PTSD who did not seek t reatment due to stigma or access
will file. We assumed that only medical costs for claims with a  PTSD diagnosis would be
142 reimbursed retrospectively. If there is a reduction in barriers to treatment and if the denial ra


ially accep ting claims that would have been
initially denied under the pre-SB 542 status quo. In general, the difference we observed between the average cost of accepted and denied claims reflects both th e causal effect of claim denial
(i.e., How


en a big differen ce with the passing of SB 542 prim arily because of the preamble of
the bill, as it in itself will he lp reduce the stigma associate d with PTSD and seeking treatment.
This was just by passing the presumption itself . —Northern Ca


support firefighters have b een getting train ing that has b een paid for by the union. It has
been longer than a year, for abou t 3 years that we have had tha t peer support run through the
union . —Southern California fire chief (FS-DC04)
Perspe


ed in seeking care for themselves. The problem is that no one
wants to file the claims. . . . The best part of SB 542 is that it really makes first responder s,
firefighters, and police officers feel supported and heard. Tha t will help them reach


tion would change the volume of
workers’ compensation mental health claims. While some departme nt chiefs and claims
administrators thought the presum ption would increase the numbe r of PTSD claims, a few others
thought that, ultimately, it would


think, that is a tough pill to have to swallow. —Northern California claims administrator for
peace officers (PN-CA01)
In addition to impacts on the claims volume, several department  chiefs noted improvements
in the claims process due to t he pre


ry and undo pain  and suffering as well as fina ncial hardship to these men and
their families.  . . . The bottom line is this: It has been far more cost-effective to  have PTSD
allowed as a presumptive injury s o that the expenses of (1) QMEs, (2)


or example, EAP
and then, if need be, to their medical group health. —Northern California mental health provider
who treats firefighters (FN-MH01)
In addition to difficulties with rei mbursement, many mental health providers noted difficulty
get


 All five
of these departments discussed a  history of suicides or other a cute events that prompted chiefs
and other officials to create mechanisms to get first responders care quickly, without having to
go through workers’ compensation. A mental


t the presumption woul d increase non-job-related cla ims, but nearly all departments
noted that the presumption has helped move claims through the s ystem faster. Having a healthy
workforce was noted as being amo ng the biggest cost-savers that  r


here are poten tial arguments against continuing the presumption in
SB 542. It could be costly to state  and local government, altho ugh there is a lot of cost
uncertainty due to uncertainty a bout the true prevalence of PTS D. It is also not clea


e officers, but it is unclear
whether they are covered by t he presumption in SB 542.
Unlike other workers’ compensation presumptions for public safety workers in the California
Labor Code, the presumption established by SB 542 will expire i n les


 Claims Process
Further in-depth study into sever al aspects of the workers’ com pensation system is needed.
Better information about claims ad ministrator practices could b e used to develop more detailed
guidelines as to what information should


al health delivery s ystem facing first responders is  based on a limited number of
interviews and cannot be assumed to represent a statewide avera ge. That said, it should not be
surprising that first responders  suffering from PTSD reported g rea


ttention to the composition of mental health prov ider networks in group health,
could help reduce the fragmentation of payers that was so delet erious to first responders with
PTSD.
The ultimate goal of SB 542 was not just to provide workers’ co


policym akers might consider
providing funding for the CHIS t o add items specifically measur ing PTSD (e.g., the PCL, known
157 as the PTSD checklist) (Bovin et al., 2016; Weathers et al., 19 93; Weathers et al., 2013a;
Weathers et al., 2013b);


e
mortality rates from the CDC do not show that male firefighters or peace officers are at elevated risk of
suicide compared with the overall male workforce. Women in protective service occupations did have elevated suicide mortality rates compared


TSD is statistically significantly higher for firefighters (0.9 percent of workers’ compensation claims) than for workers in comparable occupations, including ambulance drivers and EMTs (0.5 percent). For peace officers, results are mixed. Conditiona


ion was job-related, or in cases where there was no prior treatment or diagnosis? A: In-depth interviews with firefighters, peace officers, mental health providers, applicants’ attorneys, and claims administrators indicated that receipt of a PTSD dia


vered by ESI, and the belief that ESI would not pay bills for potentially work-related health
conditions.
RQ11: What might the costs  to state and local governments be for each  of the next five years now that SB 542 is
in effect? Please separate


etroactive claims would result in payment of medical
care benefits, but not in new indemnity benefits , state and local governments collectively might have
expected to pay an average of $13 million per year for peace officer claims and $2.6 million


ence and inform how future first responders obtain
care for mental health problems.  The interview is totally confi dential and separate from your employment,
so I won’t be involved in your interview.

Would you be interested in findin g out mor


tal health support for
employees? Is this any  different as it rel ates to a traumatic e vent that occurr ed for several
firefighters/peace officers? How long has this been the approac h at your department?
RQ3,5 3. In your opinion, does your depa


e alth insurance? What is
your experience?
RQ6,7,10 6. What are your thought s on how to reduce denied clai ms for mental health provision for a
firefighter/peace officer?
 Claims Administrators
RQ5,7,10 1. What are the main rea sons for denyin


we
drew department chiefs, mental  health providers, and claims adm inistrators for interviews.
Categories of characteristics in cluded the type of department ( i.e., fire or police), the rate of
mental health claim denials (i.e ., high or low), t


ty
Urban 3 3 50% 43%
Rural 3 4 50% 57%
Location
Northern California 3 4 50% 57%
Southern California 3 3 50% 43%
Department Denial Rate fo r Mental Health Claims
High 3 4 50% 57%
Low 3 3 50% 43%
Years as First Responder (Mean)  20


s or fidgety?
4. How often did you feel so depre ssed that nothing could cheer you up?
5. During the past 30 days, about how often did you feel that ever ything was an effort?
6. During the past 30 days, about how often did you feel worthless?
In


ey think they might
need it. Please respond with a “yes” or “no”  to tell me whether each statement applies
to your reason for not seeing a professional.
 You were concerned about the cost of treatment.
 You did not feel comfort able talking wi


unts for the NHIS’s complex survey design.
Statistical Inference
Using the weights described above , we conducted tests for stati stical significan ce for both the
binary outcome variables (seri ous or moderate mental distress) and the continuous


(3) self-insured, self-administered. In the empirical work, indicator variable s were created using the following logic: An individual was
considered to be fully insured if they were not self-insured, as define d by an indicator variable
sourced di


atory disorders
(nature-of-injury code 65); poiso ning—chemical, other than meta ls (nature-of-injury
code 66); poisoning—metal (nature-of-injury code 67); dermatiti s (nature-of-injury code
68); radiation (nature-of-injury code 70); all other occ


 4,235 372 124 73,936
Table C.3. Prevalence of Serious or Moderate Mental Distress by  Occupation, Gender, and Age, 2013–2019 CHIS
Occupation Group  First Responders and
Comparison Groups Firefighters and
Comparison Groups Peace Officers and
C


6% 36.9%
N (Unweighted) 1,170 819 2,056 238 236 494 935 583 1,565

175 Occupation First Responders Firefighters Peace Officers
Claims
Administrato r Type Self-Insured,
TPA Self-Insured,
Self-
Administered Total Self-Insured,
TPA Self-Insure


 at 24 Months, Mental Health Diagnosis on Bills (Intermediate
Definition) 18.9% 34.0% 25.1% 17.6% 36.3% 27.1% 19.1% 32.7% 24.3%
Mean Count of Denied Bills as % of Mean Bill Count, M ental Health
Diagnosis on Bills (Intermediate Definition) 17.3% 3


 total FR OI submissions and has complete
medical bill data.

180 Supplementary Resu lts for Chapter 7
Table C.8. Paid Indemnity and Medical Benefit Cos ts for First Responder Claims Involving PTSD, by Benefit Type
 First Responders Firefighte


 Context
Measures
As discussed in Chapt er 2, we used survey d ata on working condi tions and job demands
from the Occupational Informatio n Network (O*Net) program to se lect occupations to
compare with peace o fficers and firefighter s. To iden


game wardens; millwrights;
other health care practitioners
and technical occupations;
aircraft pilots and flight
engineers; wind-turbine
service techni cians; heating,
air-conditioning, and refrigeration mechanics and
installers; riggers; haza


icians;
surveying and mapping
technicians; transportation,
storage, and distribution
managers; business
operations specialists; all
other

186 Occupational
Group (as used
in this report) SOC Occupation Titles SOC Codes Census Occupation


sors of
mechanics, ins tallers, and
repairers; miscellaneous life, physical, and social science
technicians; occupational
health and safety specialists;
morticians, undertakers, and
funeral arrangers; health and
safety engineers, except
minin


groundskeeping workers;
transportation, storage, and
distribution managers;
first-line supervisors of
construction trades and
extraction workers; business
operations specialists, all
other; first-line supervisors of
law-enforcement workers;


nce
(firefighter minus
all occupations
mean)
Impact of Decisions on Coworkers or Company
Results 4.26 4.22 4.38 3.84 0.42
Frequency of Decisionmaking 4.25 4.18 4.31 3.84 0.41
Pace Determined by Speed of Equipment 2.07 2.30 1.59 1.93 0.14
St


ipment, Such
as Breathing Apparatus, Safety Harness, Full
Protection Suits, or R adiation Protection 2.84 2.09 1.22 1.37 1.69 1.15
Indoors, Not Environmentally Cont rolled 3.26 3.39 2.39 2.38 2.3 1 0.95
Exposed to Contaminants 3.70 3.54 3.08 3.07


2.95 3.05 3.42 2.71 3.10 –0.15
Degree of Automation 1.91 2.13 1.60 2.01 2.16 –0.26
Pace Determined by Speed of Equi pment 1.26 1.68 1.22 1.63 1.93 –0.67
NOTES: Mean O*Net Work context r esponses for peace officers and  comparison groups examined i


on 6.4 [data set], Min neapolis, Minn.: IPUMS, 2019.
As of June 22, 2021: https://doi.org/10.18128/D070.V6.4
198 Bovin, M. J., B. P. Marx, F. W. Weathers, M. W. Gallagher, P. R odriguez, P. P. Schnurr, and
T. M. Keane, “Psychometric Properties o


ty ,
last update January 26, 2021. As of September 9, 2021:
https://www.dir.ca.gov/dwc/DWCForm1.pdf
Department of Veterans Affairs a nd Department of Defense, “VA/D OD Clinical Practice
Guideline for the Management of Posttraumatic Stress Disord


o. 4, February 15, 2016,
pp. 737–744. As of June 25, 2021: https://www.ncbi.nlm.nih.gov/pubmed/26890595
Jahnke, S. A., W. S. Poston, N. Jitnarin, and C. K. Haddock, “Health Concerns of the U.S. Fire
Service: Perspectives from the Firehouse,” Amer


7376669
Kubiak, S. P., M. L. Beeble, and D. Bybee, “Using the K6 to Ass ess the Mental Health of Jailed
Women,” Journal of Offender Rehabilitation , Vol. 48, No. 4, 2009, pp. 296–313.
“Labor Code 5402: Division 4. Workers’ Compensation and Insuran


 As of June 30, 2021: https://www.ncbi.nlm.nih.gov/pubmed/31971929
Prochaska, J. J., H. Y. Sung, W. Max, Y. Shi, and M. Ong, “Vali dity Study of the K6 Scale as a
Measure of Moderate Mental Dist ress Based on Mental Health Trea tment Need and
Util


2, 2003.
204 Tiesman, H. M., S. Konda, D. Hartl ey, C. Chaumont Menendez, M. Ridenour, and S. Hendricks,
“Suicide in U.S. Workplaces, 2003–2010: A Comparison with Non-W orkplace Suicides,”
American Journal of Preventive Medicine , Vol. 48, No. 6,


, D . S. Herman, J. A. Huska, and T. M. Keane, “The PTSD Checklist:
Reliability, Validity, and Diagnostic Utility,” Annual Meeting of ISTSS , San Antonio, Calif.,
1993.
Weathers, F. W., B. T. Litz, T. M . Keane, P. A. Palmieri, B. P. Marx, and P.


OBJECTIVE ANALYSIS.
EFFECTIVE SOLUTIONS.
Reducing Deaths in Law
Enforcement Custody
Identifying High-Priority Needs for the Criminal Justice System
BY DUREN BANKS, MICHAEL G. PLANTY, MADISON FANN, LYNN LANGTON, DULANI WOODS, MICHAEL J.
D. VERMEER, BR


t occur in law
enforcement custody to provide necessary context to understand law
enforcement's role.
Support more-reliable and comprehensive reporting to existing systems
that rely on law enforcement participation by allocating resources to data
pro


Sponsored by Ascendium Education GroupEvaluation of the Minnesota
Department of Correction’s Career Navigators Program
Final Report
LOIS M. DAVIS, MICHELLE C. TOLBERT, SUSAN TURNER
CORPORATIONFor more information on this publication, visit www.rand.


incarcerated individuals.
The Minnesota Department of Corrections (MNDOC) recognized a key gap in its education strategic
plan—the lack of career navigators—and conceived the Career Navigators (CN) program to address this gap. The Ascendium Educatio


 of Justice
for their thoughtful review of this report.vSummary
Introduction
Career navigators assist individuals with college and training opportunities when they return to the commu -
nity and at the front end of the corrections process (while the


ted with other state staff in its design of the CN program, those who
oversaw the EMPLOY
1 and transition coordinator programs felt that they should have been more involved
in identifying gaps in services, determining how best to avoid duplication,


to include a greater emphasis on supporting transition to postsecondary education after release. The CN supervisor also hoped the career navigators could begin supporting the American Job Centers in the facilities. However, the CN program was unable


ntation and by the early termina -
tion of the program. As a result, we were unable to conduct a robust outcomes evaluation of the CN pro -
gram. Although we were unable to measure the effectiveness of the CN program in the context of no signifi -
ca


programs that align with their interests and that will enable them to earn certificates or degrees in their chosen fields. In recent years, career navigators have been increasingly viewed as being an important part of correctional education, particul


als and Approach
The process and outcomes evaluations assessed the implementation of the CN program, including who
accessed career navigator services, how successful incarcerated individuals were in developing education and CTE plans and in completi


ll its female offenders at this facility.
Moose Lake/Willow River•
 Cu
stody level: Level 3 medium, Level 2 minimum
• Th
ere are more than 1,000 male inmates at a Level 3 medium security prison off Highway 73 in
Moose Lake and another 180 minimum-s


ed post-release recidivism. The outcomes evaluation involved working closely with MNDOC to identify key outcome measures and to undertake data collection for the outcomes study. The primary outcomes of interest post-release from prison were (1) emplo


erating over a stable period of time, with outcomes examined for a robust sample. We were, however, able to document key implementation experiences and challenges and provide short-term outcome information for a number of program participants.
Road M


e used for the
outcomes evaluation results presented in Chapter Five. Specifically, we present the descriptive statistics on the background characteristics of the CN program participants and the comparison group.
Methods
For the comparison of backgr


The vast majority of CN program participants were not married (92.2 percent). Almost all CN program participants had completed a secondary education degree, with almost three-quarters having a postsecondary degree. Although the CN program was provid


r of CN program participants
were represented in the four groups defined as low, medium, high, and very high (Table 2.2).4 CN program
participants have substantial prior records. More than half had 12 or more total convictions, with almost
half ha


nt
(MNDOC, undated-b).The Sample9TABLE 2.2
Background Characteristics—Risk, Commitment County, and Offense Categories: Career
Navigator Program Participants and Comparison Group
Group
CN Program
Participants
(N = 373)Comparison
(N = 298)Total


ncluding implementation challenges and lessons learned.
Context on Career Navigators Program
Project Timeline
Figure 3.1 shows the project timeline, including when the career navigators were hired and trained and when
CN services began and ended.
C


es, creating partnerships to further expand the employer base in several different industries, and facilitating job placement.
1 MCEC is the organizational structure for teaching and learning in the MNDOC.FIGURE 3.1
Project Timeline
December 2018
Jan


Education staff and other career navigators to support at-risk participants. Serve as the primary liaison between MNDOC Education, DEED, DHS, Minnesota state, and employer partners to ensure that expectations, goals, and objectives are synchronized.


in most meetings by conference call or reviewed meeting minutes. Several months after being hired, the career navigators received cell phones and laptops, which helped them collect data and communicate with their students who were in the community.
R


provide students with the career navigator’s business cards. After release, the student was expected to call the career navigator. If that did not happen, the career navigator called them. After the initial phone call, the career navigators were req


ors began working in the facilities and community. Because of COVID-19, however, most of the qualitative data collected came from the career navigators’ experiences in the facilities.
Conception
As mentioned earlier in this chapter, MNDOC Education c


integration process at the facilities and with other staff. For instance, the education staff at the facilities had to be reminded that the career navigators were part of the education program and not a separate service.
Despite these challenges, sta


ctional facilities, with
the goal of serving up to 650 participants per year.
4 No employment code covered this type of position within the MNDOC.Evaluation of the Minnesota Department of Correction’s Career Navigators Program: Final Report20workin


Chapter Five, only 44 percent of CN program participants had been released by August 2020, when the CN program effectively ended.
Promising Features of Career Navigators Program
Despite the early implementation challenges, the CN program was beginnin


providers, who recognize the value of academic and career counseling in helping students navigate the postsecondary education system. In addition, several states have also implemented these types of programs for incarcerated students. We examined ho


w the attention of researchers and practitioners, who have documented the need for career navigators and developed resources to support these roles.
Legislation
The Second Chance Act was first passed in 2007 and reauthorized in 2018 as part of the Fi


nsure access to necessary workforce investment activities and supportive services, using, where feasible, computer-based technologies; and (B) to provide job, education, and career counseling, as appropriate during program participation and after job


t they were most successful when they customized their services to the labor market and an individual’s needs; had knowledge of education and training options; formed partnerships with community-based organizations, colleges, and employers; and were


gram,
which was designed for youth and young adults, also documented the importance of providing case management and support with navigating education, workforce development, and social services (Cramer et al., 2019).
Career Navigator Resources
To s


ment in criminal activity.
•
 Ja
ils to Jobs initiative: Launched in 2018 and expanded in 2019, Jails to Job was created by the New York
City mayor’s office to provide counseling support and tailored programming in the jail that continues after rele


eeds. For example, coordinators may provide additional support to those identified as “underearners,” meaning they are not making a living wage.
HIRE staff also focus on developing and maintaining strong relationships with employers. As noted
on th


eentry education navigators. The navigators are responsible for helping students achieve their education and career goals. They also serve as a liaison between the students, prison staff, and community college staff. In prison, the navigators work wi


 lack access to
critical services and supports and may be less likely to continue their education. When Knoth and Fumia wrote their report, colleges in the seven highest-return counties had navigators. According to the SBCTC policy associate who was


sponsibilities, and Hiring and Training Practices
Common In-Prison Roles and
ResponsibilitiesCommon In-Community Roles and
ResponsibilitiesCommon Hiring and Training
Practices
• Provide academic and career
c
ounseling.
• En
gage students in devel


d Bender, 2010).
Approach
Our outcomes analysis examined those individuals who had been released from prison as of August 2020. Table 5.1 shows the percentage of the CN program participants and a comparison group who had been released.
By August 2020


 than 5 percent of all
participants were returned to custody within six months of release. At one year, 8.5 percent of the CN program participants had been returned to prison, compared with slightly less than 12 percent of the comparison group. The


er of individuals, the reported employment quarter fell during the time that the person was in prison for
the most recent incarceration. We did not include those earnings in our analyses.
2 These percentages of participants who were employed and the


fying gaps in services, determining how best to avoid duplication, and leveraging existing resources. Some staff members felt that the career navigators should have focused primarily on education rather than employment because employment assistance w


 This, in turn, had implications for the outcomes analysis.
Delays in implementing the CN program had implications for the full implementation of the CN model.
Although the grant period began in 2018, the six-month delay in hiring (as a result of ad


mpared with slightly less than 12 percent of the comparison group. The type of prison return was similar for both groups. Less than 10 percent returned in the first year after release; the vast majority of those were supervision returns. Individuals


ITION PURPOSEThis position will work in a team setting utilizing primary partnerships with other state
agencies, including DEED, DHS, and Minnesota state; it will also partner with MNDOC departments, including reentry, parole, case management, MINNC


 state; it will also partner with MNDOC departments, including reentry, parole, case management, MINNCOR EMPLOY, and Transitions.
This position exists to provide advanced, comprehensive career planning, job search, and goal setting
with many offende


employer data and participant employment data. Create high levels of communication with employment groups and other state agencies on the benefits of hiring exoffenders. Work with partnering agencies and MNDOC Education, DEED, and the Transitions, a


                          Priority    Time    Discretion

                     A       40
%         A
Advising and participant case management: Use expertise in state agency programs and resources to make appropriate referrals for all participant


and maintain documentation and reposts that meet reentry grant guidelines.
F. Mo
nitor monthly progress reports, provide necessary follow-up, and enter required data into
the MNDOC electronic system as appropriate.
G. Cr
eate program policies and


d development purposes.
E. Re
ports for duty as scheduled. Uses time wisely. Minimizes all types of waste and is conscious
of costs. DEED Description for the Career Navigator Position45Responsibility Statement
Workplace values: Every individual is


behavioral
interventions, community resources navigation, and employment acquisition and retention techniques
3.
 Kn
owledge of WorkForce Center services
4. Kn
owledge of the DHS program resources and services
5. Kn
owledge of DEED and community res


ctly to the Education Director at the home facility and indirectly to the MNDOC Director of Career Technical Education at Central Office. Informal consultations occur as needed with seeking advice or gaining approval on such matters as how to effecti


ional, scientific, and technical services  (n, %)0.6444
a
0. No 159 (96.4%) 57 (95.0%) 216 (96.0%)
1. Yes 6 (3.6%) 3 (5.0%) 9 (4.0%)
Employment sector (year 1 post-release): management of companies and enterprises  (n, %)0.3895
a
0. No 90 (98.9%) 28


ration  (n, %)
0. No 91 (100.0%) 29 (100.0%) 120 (100.0%)
Employment sector (year 1 post-release) with zeros: public administration  (n, %)
0. No 165 (100.0%) 60 (100.0%) 225 (100.0%)
Employment post-release (first and second quarters)
(n, %)0.7163


loyment sector (first and second quarters
post-release) with zeros: wholesale trade  (n, %)0.1727a
0. No 160 (97.0%) 60 (100.0%) 220 (97.8%)
1. Yes 5 (3.0%) 0 (0.0%) 5 (2.2%)
Employment sector (first and second quarters post-release): retail trade


ond quarters post-release): administrative and support and waste management and remediation services  (n, %)0.3641
a
0. No 45 (59.2%) 18 (69.2%) 63 (61.8%)
1. Yes 31 (40.8%) 8 (30.8%) 39 (38.2%)
Employment sector (first and second quarters post-relea


RRS Correctional Adult Reentry Education, Employment, and Recidivism
Reduction Strategies
COVID-19 coronavirus disease 2019
CTE career technical education
DEED Department of Employment and Economic Development
DHS Minnesota Department of Human Serv


t, and Michael Rocque, The Predictive Performance of the Minnesota Screening Tool Assessing
Recidivism Risk (MnSTARR): An External Validation , St. Paul, Minn.: Minnesota Department of Corrections,
November 2019. As of December 29, 2021: https://mn


ncarceratedinWashingtonPrisons.pdf
Lewis-Charp, Heather, Issue Brief: Moving Justice-Involved Individuals into Employment: Michigan’s M-CAM
Experience , Oakland, Calif.: Social Policy Research Associates, September 2017. As of October 4, 2021:
http


10publ199.pdf
Public Law 113–128, Workforce Innovation and Opportunity Act, July 22, 2014. As of January 5, 2022:
https://www.govinfo.gov/content/pkg/PLAW-113publ128/pdf/PLAW-113publ128.pdf
Public Law 114–224, Strengthening Career and Technical Educ


Can Adaptive Reuse of
Commercial Real Estate Address the Housing Crisis in Los Angeles?
Appendixes
JASON M. WARD, DANIEL SCHWAM
CORPORATIONFor more information on this publication, visit www.rand.org/t/RRA1333-1 .
About RAND
The RAND Corporation is


 expanding the housing supply that
includes increasing the production of both publicly funded affordable h ousing and market -rate
housing, incentivizing increased density for infill housing projects, doubling down on such
innovations as modular h


 ................................ ................................ ..........................  60
Tables
Table A.1. Mean Characteristics of Underutilized Commercial Real Estate in Los Angeles  ...... 15
Table B.1. Common City of Los Angeles Multi


ta cut we use is to restrict our attent ion to properties in Los
Angeles County. The other restrictions we incorporate relate to characteristics that we
hypothesize to be more likely to make a property amenable to adaptive reuse  (AR). We list each


cal
area in our analysis.  Apart from mean travel time to work, our variables of interest can simply be
summed across all census tracts to yield a value for the CPA or other municipal area. A similar
procedure is performed  for the microdata extra


the meaning of vacancy is different for  hotel/motel properties versus office
and retail properties. For this class of properties, vacancy rates measure the available rooms at a
point in time. Furthermore, the hotel/motel sector has experienced a


ood . Within the
boundaries of the City of Los Angeles , we use subareas called  CPAs. These areas are
geographies defined in the City of Los Angeles ’s General Plan Land Use Element that are used
to establish neighborhood -specific goals and plan


each. Although these municipalities (e.g., Torrance, Inglewood, El Segundo) are
technically “contained ” by the narrow strip of Los Angeles linking the Port of Los Angeles to the  core of the city,
we viewed them as less integrated into the geograp


 Can Have Lower Development Costs
High housing production  costs in Los Angeles have been highlighted as an important
limitation on future economic growth and an impediment to social mobility (Nichols, 2019;
Woetzel et al., 2019) . Factors behind


 the inclusion of restrictive labor
regulations that has led to the recent failure of numerous housing -related bills (Tobias, 2021) .
Lacking this so rt of streamlining, developers interested in pursuing the AR of CRE may need
to rely, instead,


30 beds under
the R4 use and must be a minimum of 600  feet from another shelter outside the Central City CPA). See Los Angeles
City Planning, 2020,  for more details.

In many cases , however,  a change of use, even to a permitted residential u


ible for). Properties acquired for the purpose of
demolition and new construction may not be used in this manner.
Other Incentives May Increase the Feasibility of an Adaptive Reuse Project
Programs aimed at incentivizing denser housing or more -


ng development. Such coalitions have successfully defeated numerous state -level
upzoning measures , including the controversial SB 50, which failed to pass in 202 0 (Koseff,
2020).
CRE conversion may sidestep both of these strains of opposition.


nable to reach through email or phone messages.
The group we interviewed over this period comprised
• three Los Angeles –based architects
• one Los Angeles –based structural engineer
• one Los Angeles –based developer of market -rate projects


ince spreading the fixed costs of any AR project across more units will reduce per -unit
costs (as is also the case for new construction projects). However, differences in
acquisition price and num erous other factors may affect the viability of sp


ility upgrades. Existing utilities in commercial buildings will usually require
substantial upgrades. Affected systems often include electrical service, fire and domestic
water pumps, f ire hydrants, sewer service , and heating, ventilation, and ai


struction costs
and the diversion of the entire developer fee into the p roject allowed for this project to be
completed. Another expert who has worked on numerous projects in DTLA suggested
that a building code change that accompanied the 2000 Lo


nt
approvals for nonconforming conditions in a building, reducing delays and redesigns.
• High levels of coordination among team members.  Multiple interviewees also stressed the
need for a much greater  than normal level of interaction and commu


ified as “homeless” under the federal McKinney -Vento Homeless Assistance
Act (National Center for Homeless Education, undated) —may complicate conversions  of these
properties into permanent housing. A potential upside of this phenomenon is that m


t by a requirement that the average unit size
of an AR project be 750 square feet. Figure B.1 demonstrates the effe ct of such an average size
requirement by tracing out a curve that relates the number of 450 -square-foot units included in a
100-u


450 Square Foot Units
(Out of 100)
Size of Remaining Units Required to Meet 750 Square Foot Average  28 without provisions for parking but quickly discovered that this was not an issue at all in terms of
finding tenants for the h ousing. Research o


arth of larger projects and that these projects affected by the
agreement had construction costs that were approximately 15 percent higher than projects not
affected by the agreement. To increase the c omparability of the projects used in this anal


since the former units are simply larger , meaning
that each unit costs more in materials. The inclusion of this variable along with the
number of units in each project also effectively controls for the overall size of the project ,
since the actu


terest rate of various
bond funding programs (for example, Proposition HHH –funded projects were eligible for
a 50 percent interest rate reduction).
• Controls for the target population types of a project.  Specific characteristics of
supportive


ese project s primarily use buildings that had some history of serving as housing or
quasi-housing (two were apartment buildings in poor condition, two were small hospital -related
facilities, and one was originally a school that had also served as


, Southgate, Downey,
Bellflower, Norwalk, Santa Fe Springs, La Habra Heights, La Mirada, Norwalk, Lakewood,
Compton, Hawaiian Gardens, Southgate, Mayw ood, Commerce, Paramount, Artesia,  and
Cerritos; and parts of unincorporated L os Angeles Count


 excludes class A properties .
Figure C.2 . Sale Prices for Studio Apartments and Equivalent Area in Office Properties
Panel A. Western Los Angeles    Panel B. Central Business District        Panel C. Southeast Los Angeles

SOURCE : Author cal


by about 40 percent, from an average rate of about 6.5 percent to 9
percent by late 2020.15 There is evidence of a broadly similar pattern in retail vacancies, but the
magnitude is about ha lf the size, or about 20 percent (an increase from about 5


effects of COVID -19 on
the utilization of different types of CRE. Hotel and motel vacancies reflect significant declines in
revenue and a higher probabili ty of fiscal distress in this property sector (Singh, 2021) . Increases
in office vacancies


9. Retail
real estate prices are likely to continue to decline because of  the pandemic (especially apparel,
consumer electronics, and furniture ) with a continued increase in brick-and-mortar closures
(Wahba, 2021) .
Hotel and m otel properties


se as interim or permanent housing
for people experiencing homelessness under the state of California ’s Project Homekey.
We note again that this approach to generating an analysis sample is crude and that th e
complexity that is typical of many


nt, high -quality transit , and other
amenities, as well as addressing historic patterns of discrimination through downzoning and
other means that have reduced social and economic opportunities for racial and ethnic minorities
and low-income indiv


le) ; average commute time to work  Greater proximity to high -quality transit and
lower commute times will reduce vehicle
miles traveled.
Access to jobs -rich areas  Number of workers per square mile  Higher numbers of worker per square mile
in


socioeconomic opportunities for residents. It is notable tha t most of the
Project Homekey acquisitions we identify are within these transit corridors, reflecting the fact
that this criterion is part of the points system used in awarding this fundi


buted across areas, so certain CPAs in our analysis may have relatively high transit
ridership, while many others reflect nearly 100 percent car commutes. To the extent that transit
users experience longer commutes because of the  mode of transport


 lower than
current rents. Using Zillow rental cost data for City of Los Angeles single -family plus
multifamily properties from the beginning of 2017 (the midpoint of the time span of our Cens us   48 Bureau data) to September 2021, we calculate t


rea comprising thousands of luxury high -rise condominium properties.    49 density for each of the 43 CPAs and municipalities to generate a single i ndex that allows these
geographies to be ranked by this simple proxy measure of area resources and


he distribution of underutilized CRE
overlaid on a map of Los Ang eles County subdivisions.
Figure E.5. Distribution of Underutilized Real Estate  at the County Subdivision Level,  by Mean
Travel Time to Work
Panel A. Hotel/ Motel Properties


r this  study. I will share their contact information with you via email, text, or verbally,
whichever you prefer.

[Information to be provided:
The RAND Human Subjects Protection Committee can be reached toll -free at (866) 697 -5620 or by
em


ing over lays?

3. What challenges in putting together funding are unique to adaptive reuse projects
relative to new construction?
a. Potential probes: Are traditional sources of funding like LIHTC credits available
once rezoning has been secu


Areas Previously Reserved for Single -Family Homes, ” The Oregonian , August 13, 2020.
As of November 30, 2021:
https://www.oregonlive.com/portland/2020/08/portland -changes-zoning-code-to-allow-
duplexes-triplexes-fourplexes -in-areas-previously


 Reject Turning Parking Lot into 500
Housing Units, ” San Francisco Chronicle , October 28, 2021.
Duara, Nigel, “Newport Beach Was Supposed to Build 2 Affordable Units in 8 Years —Why So
Little?” CalMatters , January 8, 2021 . As of October 14, 2


view of Proposition HHH , Los Angeles:
Los Angeles Office of the Controller, October 8, 2019. As of October 13, 2021:
https://lacontroller.org/audits -and-reports/high -cost-of-homeless-housing-hhh/
Lall, Jessica, Marie Rumsey, Shane Phillips, an


 -2020-greater-los-angeles-homeless-count-results
Manson, Steven, Jonathan Schroeder, David Van Riper, Tracy Kugler, and Steven Ruggles,
IPUMS National Historical Geographic Information System: Version 16.0 [data  set],
Minneapolis, Minn.: IPUMS,


, Mills Act Program Application
Guide 2019 , Los Angeles: City of Los Angeles, January 2019. As of November 30, 2021:
https://planning.lacity.org/odocument/e822f19f -4756-40c8-8e41-
27bed9057bc1/2019% 20Mills%20Act%20Application%20Guide_FINAL_1.pd


dix D :
Historic Preservation , Washington, D.C., January 28, 2016 . As of February 25, 2022 :
https://westladraftmasterplan.org/documentation/draft -master-plan
Wahba, Phil, “UBS Sees Another 80,000 U.S. Stores Closing by 2026, ” Fortune, April 5


Police Killings: Road Map of Research Priorities for Change
In this report, RAND Corporation researchers summarize what is currently known
about killings committed by police officers in the United States and identify existing
evidence about various


pursue transparency in our research engagements through our commitment to the open
publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to
ensure intellectual independence


disruptive technologies on risk and security. For more information about the RAND Center for Global Risk
and Security, visit www.rand.org/international/cgrs.html or contact the director (contact information is pro -
vided on the webpage).
RAND Soc


ice violence more broadly) from a critical mass of agencies. This
lack of data has a domino effect on research, restricting the topics that can be assessed and the rigor with
which such assessments can be done. Without better evidence, the ability


med at reducing police violence.
Research Priorities
In each of our five main focus areas—data and reporting, training, policies, technology, and consequences
for officers—and at the foundational level, we identified several priority research topics


for research on this topic. Also at the foundational stage is data: Before the Summaryviistate of research on police killings can truly be improved, data collection by agencies on these behaviors—
regardless of the legality or reasonableness of an in


t effects on police violence and killings to further reduce an agency’s number of incidents
involving police violence.
14. Clarify the role of policies in governing technology use, including a focus on technology
implementation.
Technology 15. Cons


ding police leadership and decisionmaking. Sherman, 2018, identified some of the most
commonly recommended interventions for police killings (body-worn cameras [BWCs], de-escalation train -
ing, implicit bias training, early intervention systems, an


 of the term use of force exists, it has been used to refer to a range of behaviors, from
verbal commands to serious injury or death. With the recent scrutiny on incidents in which excessive force
has been used, some scholars have described use of


heir aftermath. Chapter Two provides more detail on this issue. Despite significant data challenges, several
major efforts have been undertaken to collect nationwide counts of and basic details about police killings,
allowing estimates of prevalenc


ns happen and how to reduce them, we must first
recognize that not all violence used by officers against civilians, or even all fatal police shootings of civil -
ians, are excessive, wrongful, or criminal. As Bittner, 1974, described, “Police are em


faced by the officers” (Alonso, 2018). The Graham case fur -
ther clarified that, because “officers are often forced to make split-second judgments—in circumstances that Police Killings: Road Map of Research Priorities for Change4are tense, uncertain


 of force itself, and often prior to the subject’s noncompliance,
resistance, or other physical actions upon which the use of force is immediately predicated.”
These conclusions suggest that an extensive number of factors go into officer decisionmak


ons.
To narrow the scope of the literature search to the most relevant sources, we identified five high-priority
thematic groups—or focus areas—that captured the most published research and the most commonly dis -
cussed topics regarding police kil


viewees were identified from
the research team’s professional networks; for additional interviewees, we used snowball sampling based on
recommendations from previous interviewees. The interviews were semistructured, following a unified topic
guide


on, however, we identified three issues that are threaded through -
out most of the literature we reviewed and that are central to understanding police violence in the United
States today: racial inequalities, traditional policing culture, and polic


accuracy—or lack thereof—in police records in which race and ethnicity are recorded. Often, the race or eth -
nicity of people who come into contact with police is simply not recorded. When it is recorded, the listed race
or ethnicity is likely base


outcomes: “Policing as a response to crime
problems is in itself a policy decision that has implications for communities” (Weisburd and Majimundar,
2018).
Police Culture
Police culture and police unions can work in tandem to frustrate reform effort


; Cunningham, Feir, and
Gillezeau, 2020), although this attention to unions is relatively recent (Harris and Sweeney, 2021). Police schol -
ars have argued that some elements of police culture—especially those that prevent officer accountability—
ca


e more
accountability. For example, in Boston, the mayor-elect campaigned on police reform in 2021 and aims to
make changes in union contracts, which expired in 2020, to force structural change in the police department
(McDonald, 2021).Police Kill


rmative) where changes can be made and their implications for racial inequities.
2. Conduct research on aspects of law enforcement that teach and reinforce traditional police cul -
ture and norms and on how reform efforts might overcome resistance st


mmission on Civil Rights provided recom -
mendations to the Federal Bureau of Investigation (FBI) to properly collect and make available information
on police violence. This urgent call from the field has remained consistent (White, 2016). Clear dis


ng programs.
The analysis found that nearly half of police killings were not captured by existing federal monitoring sys -
tems. It confirmed the accuracy of crowdsourcing estimates that the actual number of killings in 2014 and
2015 by police was


time lag between data collection and publication, making it not useful to agencies; and the lack of
proper data collection capabilities and uniform standards. Several interviewees claimed that although previ -
ous similar efforts have failed, they h


Texas, Colorado, and Maine also require agencies to submit use-of-force data. Interviewees recommended
that other states replicate these efforts. We heard that, of the states with a data mandate, Texas may have the
best data in the country.
We spe


upon way to measure use of force (Shjarback, 2018). Because of this, with the exception of some states with Police Killings: Road Map of Research Priorities for Change16TABLE 2.1
Comparison of Publicly Available Databases Reporting Police Killings
M


 enforcement officer acting in the line of duty.Data and Reporting17advanced state-level data collection efforts, it is very difficult to compare statistics across agencies. The lack
of consistency in measurement of use-of-force research is concerni


Agenda Priorities and Recommendations
1. Explore additional data sources and data that could provide a more reliable representation of a
police violence incident.
 –One possibility of additional data sources is that body-camera footage (Peeples, 202


 involved. Overall, there is not enough pressure from police department leadership to pro -
vide complete and correct data.
3. Put more effort into collecting data on nonfatal police violence.
 –Often the difference between a fatal and a nonfatal ou


most likely to be encountered in the real world (Dayley, 2016).
Recent work has found that officers’ physiological responses during stressful situations can affect their
cognition and behavior, but, over time, officers can learn to adapt to the str


horrible.”
Experts identified implicit bias training as a popular current focus in many departments. Although lim -
ited, the research on implicit bias training has thus far found a change in officer attitudes  after the training,
but no difference


ilians to feel a sense of moral alignment with officers, which enhances police
legitimacy . . . and thereby promotes cooperation and compliance” (Terrill, Paoline, and Gau, 2016). One
element of procedural justice involves giving citizens a chance


in certain situations, such as if a suspect was fleeing or if the suspect had stolen
a car (Phillips, 2015). There was a positive correlation between officers who felt that it was acceptable to use
verbal force (i.e., to swear at a suspect) and off


 for improvement in current training approaches. Perhaps the emphasis in training on use of
force and not de-escalation is part of the explanation for the high level of police shootings. It is no surprise,
then, that all of the interview participan


making skills.
 –Evaluate scenario-based training, in which officers are put through realistic role-playing exercises in
which they must make choices about how to respond to the types of incidents they may face.
 –Explore possible transferrable le


 developmental disabilities (Wright, 2016), mental health
challenges, and other conditions should be included in officer training
 –More-realistic, scenario-based training could improve officer performance but needs more develop -
ment and research


olicies in agencies across the United States (Oba -
sogie and Newman, 2017; Sinyangwe, 2016; Alonso, 2018; Jennings and Rubado, 2017; Garrett and Stoughton,
2017; PERF, 2016). The reviews agree that there is very little consistency in use-of-force p


ty of human life . . . at the heart of everything an agency does” (PERF, 2016, p. 34). That report also
advised that while agencies do not have to create policies that are stricter than the Graham  standard, they
should. Thirteen of the principles


ies identified by Campaign Zero have a great deal of overlap with PERF’s guiding principles.
Campaign Zero conducted an analysis of the impacts of these policies on police killings in 91 agencies and
found that the two policies with the greatest im


es found that this lack of definition made it harder to identify these use-of-
force incidents in event reviews and made it easier for officers to obscure such actions within reports. This
is likely true of departments across the country with vague


on drawing a weapon are
necessary for fully understanding police killings and how to reduce them (Wheeler et al., 2018)—especially
with regards to understanding whether and the extent to which racial bias plays a role in police killings. The
autho


 Policies29to disrupt. The findings about addressing networked misconduct echo the discussion in Walker, 2018, on the
use of administrative policy to chip away at the police culture in support of greater officer accountability.
Further working to ch


lice killings but also demands more-specific knowledge about how these
policies are implemented and how they work. Campaign Zero and other policy review studies thus present a
starting point for additional research into specific policies, their imp


we get agencies to change their policies? A great deal of agency resistance to change is related
to official agency policies: Because Constitutional bare minimums for use of force are a low bar, and agencies
are not required to abide by a standard


 easy-to-use forms. Research is needed on how such policies Policies31should be written and implemented and how best to gain officer compliance with such reporting
policies.
2. Identify the mechanisms by which specific policies reduce officer use of


-race pairs of
police were the least intimidating and threatening to citizens, reducing officer perceptions that force
is necessary, and that pairing experienced and inexperienced officers together can reduce use of force.
Policies that formalize


 models, taking advantage of the staggered
rollout of BWCs across U.S. law enforcement agencies. Of the three models, two indicated significant reduc -
tions in civilian fatalities as a result of BWC adoption. In addition, we are aware of one non–pe


2019, based on observations and interviews shows that at least
some officers view electroshock weapons as alternatives to lethal force, including in situations where they
believe lethal force would have been justified. At the same time, the study f


her a suspect has a weapon, officers rely on the information provided by dispatch. Incorrect dispatch
information may thus lead to unnecessary use of force or a shooting. Despite evidence from these studies,
they were both conducted in experimental


tal context mentioned
above. The first is differences in levels of cross-stakeholder integration and cooperation in relation to BWC
implementation (which can affect the outcomes themselves); the second is differences in methodologies and
definitio


of the
implications of the paper by Ba and Grogger, 2018, is that training seems to matter, although this is a sugges -
tion based on use of force not involving firearms.
What are the circumstances of less-than-lethal use of force and its potential


 use and effectiveness varies
by officer or unit types.
 –Future research studies should conduct analyses at a more granular level—i.e., at a level smaller than
department-wide analyses. This approach would ascertain whether it is possible that cer


orce used, and progression of the
encounter since its initiation or since the officer’s dispatch.
6. Clarify the role of policies in governing technology use, including a focus on technology imple -
mentation.
 –Future studies should also examine t


nvolved: (1) Prosecutors are reluc -
tant to charge police officers, (2) grand juries are reluctant to indict, (3) trial juries rarely convict officers, and
(4) judges punish convicted officers comparatively lightly (Rose, 2018).
It is extremely dif


 of civilian oversight are increasingly used to monitor and review police departments.
In addition to internal review mechanisms, law enforcement agencies are also increasingly subject to various
forms of civilian oversight (Ali and Pirog, 2019; St


atic assessments of their effectiveness, both in general and specifically with respect to
police violence (Stageman, Napolitano, and Buchner, 2018; De Angelis, Rosenthal, and Buchner, 2016). A
review of these boards (Decker and Shjarback, 2020) ide


bar for justifying officer actions. In this regard, individual states can adopt their own standards of reason -
able use of force, as was recently done by California (Commission on Peace Officer Standards and Training,
undated). Understanding the po


 ■abolishing qualified immunity or introducing higher standards (Christman, 2017; Cover, 2016)—
for instance, some locations are passing laws limiting qualified immunity and/or requiring officers
to pay part of settlements out of their own pockets (


ufficient, reliable, and systematically collected data that
can be compared with data from other agencies. Before the state of research on police killings can truly be
improved, data collection by agencies on these behaviors—regardless of the legal


rm efforts might overcome resistance stemming from culture and norms.
3. Conduct research on the role of unions in preventing accountability to agency policies and in shaping
the outcomes of cases involving police killings.
Data 4. Explore additiona


ous research will allow police executives to better select approaches that are best for
their department, using solid evidence in their decisionmaking.
Outlook
The preceding sections offer a number of research recommendations that can shed light on


or
agenciesConsequences
• Role of prosecutors in
outcomes after unjusti/f_ied
police killingsPolice Killings: Road Map of Research Priorities for Change46the agency or to make the agency look bad. In some instances, even when the leadership of pol


nal important lever is pressure on local elected officials, who nominally oversee police departments
and are thus in a position to push for change in police practices and policies. Pressure on local officials can
also lead to changing of the police


 (Graham, 2021) has threatened to shift attention away from discussions on police reform.
Some cities even increased police budgets after publicly committing to taking a hard look at police resources
and need (Covert, 2021). So, while progress has


magazine/newspaper sources will be included.
• Only publications since 2018 will be included.
• Non-empirical sources will be included.
• Only sources focusing on the United States will be included.
• If not describing an actual executed policy chang


 OR sheriff OR cop OR cops OR policeman OR policewoman
OR policemen OR policewomen)
• Google Scholar Search 9: fatal AND (police OR sheriff OR cop OR cops OR policeman OR policewoman
OR policemen OR policewomen)
• Google Scholar Search 10: deadly A


ssociation of Chiefs of Police
LEMAS Law Enforcement Management and Administrative Statistics
NUFDC National Use of Force Data Collection
NVDRS National Violent Death Reporting System
NYPD New York Police Department
PERF Police Executive Research For


nie, Jonathan, and Christy E. Lopez, “Keeping Each Other Safe,” Police Quarterly , Vol. 20, No. 3, 2017,
pp. 295–321.
Aspinwall, Cary, and Simone Weichselbaum, “Colorado Tries New Way to Punish Rogue Cops,” The Marshall
Project , December 18, 2020


=gscholar&cbl=1336360
Buehler, Emily D., State and Local Law Enforcement Training Academies, 2018—Statistical Tables (NCJ 255915) ,
Washington, D.C.: Bureau of Justice Statistics, 2021. As of July 24, 2020:
https://bjs.ojp.gov/sites/g/files/xyckuh


21:
https://www.cityofws.org/DocumentCenter/View/16499/4-Line-item-adopted-budget-w-notes-Police-FY-21
Civil Rights Division, The Civil Rights Division’s Pattern and Practice Police Reform Work: 1994–Present ,
Washington, D.C.: U.S. Department of


ing the Use of Force: De-Escalation Training for Police Officers , thesis, Monterey, Calif.: Naval
Postgraduate School, 2016. As of July 24, 2020:
https://calhoun.nps.edu/bitstream/handle/10945/50529/16Sep_Dayley_Eric.pdf?sequence=1&isAllowed=yPol


Agency
Policies on Conducted Energy Device Use and Police Use of Lethal Force,” Police Quarterly , Vol. 17, No. 4, 2014,
pp. 328–358.
Fisk, Catherine L., and L. Song Richardson, “Police Unions,” George Washington Law Review , Vol. 85, 2017,
p. 71


, Nancy La Vigne, Jennifer Yahner, and Amanda Geller, The Science of
Policing Equity: Measuring Fairness in the Austin Police Department , Washington, D.C.: Urban Institute, 2016.
As of October 20, 2021:
https://www.urban.org/sites/default/files/


olice Use of Force:
Data Quality Concerns and the Potential (Mis)Use of Statistical Evidence to Address Police Agency Conduct,”
Criminal Justice Policy Review , Vol. 27, No. 5, 2016, pp. 455–479.
Hollis, Meghan E., “Measurement Issues in Police Us


thal Force: Remedying Shooter Bias with Marial Arts Training,” Law &
Contemporary Problems , Vol. 79, No. 3, 2016, pp. 145–172.
Levin, Benjamin, “What’s Wrong with Police Unions?” Columbia Law Review , Vol. 120, No. 5, 2020,
pp. 1333–1402.
Lin, Y


Journal of Quantitative Criminology , 2021, pp. 1–32.
Moyer, Michael, Police/Citizen Encounters: An Examination of Less Lethal Weapons, Their Effectiveness, and
Officer Decision Making, Fayetteville, Ark.: University of Arkansas, Fayetteville, 2015


learinghouse/
OIG-NYC-Police_Use_of_Force_in_New_York_City.pdf
Phillips, Scott W., “Police Recruit Attitudes Toward the Use of Unnecessary Force,” Police Practice & Research ,
Vol. 16, No. 1, 2015, pp. 51–64.
Richardson, Joseph B., Christopher St


Officer
Decision-Making and Force Used or Avoided in Arrest Situations: Tulsa, Oklahoma and Cincinnati, Ohio Police
Use of Force Narrative Data Analysis Report , Cincinnati, Ohio: International Association of Chiefs of Police/
University of Cincinn


cy: Procedural Justice,
Use of Force, and Occupational Culture,” in Mathieu Deflem, ed., The Politics of Policing: Between Force and
Legitimacy , Bingley, UK: Emerald Group Publishing, 2016, pp. 59–76.
Thomas, Kyle J., Peter A. Collins, and Nichol


ly Force: Reexamining the Importance of
Administrative Policy,” Crime & Delinquency , Vol. 47, No. 1, 2001, pp. 131–151.
———, “Transactional Encounters, Crisis-Driven Reform, and the Potential for a National Police Deadly Force
Database,” Criminol


 Alexander Coppock, Evaluating the Effects of Police Body-Worn
Cameras , Washington, D.C.: The Lab@ DC, 2017. As of July 24, 2020:
https://bwc.thelab.dc.gov/TheLabDC_MPD_BWC_Working_Paper_10.20.17.pdf
Zimring, Franklin E., “How Many Killings by Po


CORPORATIONResearch Report
JASON M. WARD, DANIEL SCHWAM
Can Adaptive Reuse of
Commercial Real Estate Address the Housing Crisis in Los Angeles?
Adaptive reuse (AR) refers to the repurposing of a building for a new, more valuable use
while preservin


rojects (Hernandez, 2018). • Los Angeles County Supervisors Hilda Solis
and Kathryn Barger in February 2021 pro-posed that the county develop a list of unde-rutilized CRE that could be rapidly trans-formed into both temporary and long-term housing f


tel/motel properties are primarily located in lower-ranked areas, whereas office properties are more common in higher-ranked areas.
 QInsights from a series of expert interviews with architects, developers, and engineers with AR experience
suggest


ing, convert-ing an old warehouse into a dining hall, converting a hotel into housing, etc. In this report, we focus solely on the adaptive reuse of commercial build-
ings for residential purposes . More specifically,
we consider three types of comm


nd publicly funded affordable housing. This dual focus is motivated by the fact that RHNA hous-ing goals are distributed according to the following household income levels used by the U.S. Depart-ment of Housing and Urban Development: very low income


ple index of socioeconomic and environmental factors. Section 5 looks at characteristics of AR policy through the lens of existing and proposed policies in Los Angeles, concluding with additional factors that may warrant further attention when creati


ugh the state’s Project Homekey initiative. Across the state, 94 hotels were purchased in 2020 and 2021 for this purpose, with 28 of these in the Los Angeles region (California Department of Housing and Community Develop-ment, 2021).
3 Early evidence


ewis, 2021).
A 2021 report projected that, across the United
States, 20,000 housing units associated with AR proj-ects would come online in 2021 (Ciuntu, 2021). The same report estimated that AR projects representing another 52,700 units will start


sting building to be
used in the calculated project value (or basis ),
which determines the maximum award that
can be applied for. This is not the case when an existing building is slated for demolition.
• Other streamlining legislation could inc


ution
 – remediating structural deficiencies, such
as water damage to below-grade walls, 8the presence of asbestos or lead paint, and
unpermitted past additions or alterations that are not code compliant.
• Although historic building status can qua


1 provides a breakdown of the numbers of
underutilized CRE properties by type according to these two geographies, the total square feet of these properties, and two scenarios estimating the number of units that each property type could yield if full


dings and $69 for residen-tial buildings (Preservation Green Lab, 2016). This amounts to 60 percent cost savings for commer-cial projects and 26 percent savings for residential projects.
Additional evidence on recent costs related to
converting hote


er unit in total, or approxi-mately $62,000 per unit in conversion costs on top of an acquisition cost of just under $200,000 per unit (Tingerthal, 2021a). One affordable housing devel-oper we interviewed estimated that the total per-unit development


ents that were not clear at the start of the project. Using construction
costs as the outcome, we found that AR projects cost 48 percent less than new construction projects ($164,000 less per unit).11Assessing Adaptive Reuse Feasibility
Using Marke


Central Business District) to $185,000 per unit (West Los Angeles). These gaps suggest that a developer could spend up to this amount per unit on conversion costs (includ-ing any fees or profit) if these units could later be sold at current market pr


 office properties except perhaps in lower-cost areas, such as the Southeast Los Angeles submarket (and, even then, only for the development of studio units). FIGURE 1
Price Differences Between Multiunit Re sidential and Commercial Real EstateSale –


eduction goals (Bed-sworth, Hanak, and Kolko, 2011). Fully accounting for these factors may justify the use of significant incentives or subsidies to produce housing in these high-resource areas.
To provide evidence on how the distribution
of under


sOffice Building Area
Retail
PropertiesRetail Building Area
Square
FeetPercentage
of TotalSquare
FeetPercentage
of TotalSquare
FeetPercentage
of Total
Westwood 92 1 5,700 0.1 8 150,912 1.1 6 137,983 0.1
West Los Angeles 88 3 27,600 0.7 26


35,050 0.9 5 91,005 0.7 4 83,778 2.9
South Los Angeles 21 33 236,200 6.1 3 144,407 1.1 6 78,585 0.3
SOURCE: Author calculations using CoStar, U.S. Census Bureau, and City and County of Los Angeles data.Table 2—Continued16the city’s focus on this area


third of the floor area of the associated room or space below it.
• The application of alternate building codes
and code interpretation for qualifying projects that provide greater flexibility in satisfying, for example, fire and safety requirements


construction. However, these standards are all written to provide (in the words of the Division 85 code) a “reasonable level of safety to the building occupants . . . in conformance with the provisions of California Health and Safety Code Section 17


loping approaches to use these rankings
to incentivize privately funded projects might prove
more difficult, since investors in a given project may not place specific value on the more abstract socioeconomic characteristics of a project. However, u


of
projects that could produce needed market-rate hous-ing potentially being abandoned because of these requirements. The creative use of purely incentive-based mechanisms, such as time-limited property tax abatements (which would likely require sub


 a detailed descrip-tion of the data and the regression models used.
8  We employ apartment size data from Chen, 2019, and Balint,
2018, using 450 square feet for studio apartments, 725 square
feet for one-bedroom apartments, and 1,150 square feet


ounty the task of planning
for more than 340,000 units of housing for “above-moderate
income” households (those earning more than 120 percent of the
area median income level) over the next eight years (Southern
California Association of Governmen


from 2017
to 2021 in Los Angeles using a common set of funding sources,
making them subject to many common cost-drivers, including
city regulations and planning requirements, regional labor and
materials costs, and several funding source–specific


2021.
Brown, Eliot, “Casualty of Cities’ Resurgence: The Suburban
Offices Left Behind,” Wall Street Journal , February 8, 2016.
California Department of Housing and Community
Development, “Final Homekey Awards,” data set, accessed on October 13,


Making It Work: Legal Foundations for Administrative Reform of California’s Housing Framework,” Ecology Law Quarterly, Vol. 47, No. 4, 2020, pp. 973–1060.
Frazier, Mya, “When No Landlord Will Rent to You, Where Do
You Go?” New York Times Magazine ,


ewis, Rebecca C., “Dueling Proposals to Convert Commercial
Properties into Housing,” City & State New York , April 2, 2021.
As of October 12, 2021: https://www.cityandstateny.com/policy/2021/04/dueling-proposals-to-convert-commercial-properties-int


g Supply and Strengthen Accountability, Highlights Comprehensive Strategy to Tackle Housing Crisis,” press release, Oakland, Calif., September 28, 2021b. As of January 31, 2022: https://www.gov.ca.gov/2021/09/28/governor-newsom-signs-legislation-to-i


to End Homelessness, August 2021a. As of October 7, 2021: https://endhomelessness.org/wp-content/uploads/2021/08/Best-Inn-H2H-Case-Study_8-4-21.pdf
———,  “C a s a  L u n a ,  N a t i o n a l  C o m mu n i t y  R e n a i s s a n c e  (C O R E)
and U


n, Tim Ward, Shannon Peloquin, Steve Kling,
and Sucheta Arora, Affordable Housing in Los Angeles: Delivering
More—and Doing It Faster , McKinsey Global Institute,
November 2019. As of October 7, 2021: https://www.mckinsey.com/industries/public-and


s earning 30 percent
to 80 percent of area median income and for the creation of 197,000 units for
families earning more than that amount. Meeting this goal would require the
production of more than 100,000 homes per year over the next eight years


Sponsored by the Mayor’s Office for Economic OpportunityEvaluation of Mental Health
First Aid in New York City
Appendixes
EUNICE C. WONG, MICHAEL STEPHEN DUNBAR, DANIEL SICONOLFI,
ANTHONY RODRIGUEZ, CHESTER JEAN, VANESSA N. TORRES,
ROSEMARY LI, M


ment of Corrections (DOC)
5. Department of Education (DOE)
6. Department of Health and Mental Hygiene (DOHMH)
7. Department of Homeless Services (DHS)
8. Department of Housing Preservation and Development
9. Department of Information Technology


 a
mental health problem or crisis to seek
professional help  1 2 3 4
f Assisted a person who was dealing with a
mental health problem or crisis to connect
with community, peer, and personal supports  1 2 3 4
g Become aware of my own views and


Jay has been so desperate, he has been thinking of ways to end his life.
 What, if anything, do you think is wrong with Jay? Please type your answer below. [PROGRAMMER: OPEN-ENDED. ALLOW 500 CHARACTERS] SCENEA2 The next few questions contain stateme


 community feel that
seeking treatment for mental health challenges
is a sign of personal failure.  1 2 3 4 5
k Most people in my community think less of
someone with a history of mental health
challenges.  1 2 3 4 5

MHG2 How confident do you


ollowing questions ask about your workplace. Please indicate how much you agree or
disagree with each statement.

Strongly
Disagree  Disagree  Neither
Agree
nor
Disagree  Agree  Strongly
Agree  Not
Applicable
a I feel comfortable util


 be most interested in learning more about? Please rank
them in order by entering 1, 2 and 3.
1. Additional intervention skills
2. Grief/bereavement
3. Coping skills
4. Domestic violence/intimate partner violence
5. Eating disorders
6. Effecti


ther (specify)

[PROGRAMMER: SELECT ALL THAT APPLY] DEM10 Are you Hispanic or Latino?
1. Yes
0. No

[PROGRAMMER: SELECT ALL THAT APPLY]
DEM11 Which of these groups best represents your race? (Select all that apply)
1. American Indian or Alask


nything, do you think is wrong with Jay? Please type your answer
below.
 Open -ended free
write-in
Knowledge of referral
resources  I know wh ere I can refer individuals for help with their emotional or mental
health challenges, including alco


 self -harm?
 . . .encouraged to get professional mental health treatment?
Reach Within Social
Network  For each type of person, please indicate how many people you have used
Mental Health First Aid skills with in the past 6 months?
 A fri


ion s
Perceptions of
Future Training
Needs  I could use additional training to apply MHFA skills in my workplace  1 = Strongly
disagree; 5  =
Strongly agree  I could use additional training in other mental health skills/topics (different
than


 or crisis  Asked a person
whether they are
considering killing
themselves  Actively and
compassionately
listened  Offered basic “first
aid” and
reassurance  Assisted with
seeking
professional help  Assisted with
connecting to
community
s


 . ” (response options , never to frequently). Dichotomized for analysis as 1  = occasionally or
frequently, 0 = never or rarely .
CI = confidence interval. MHFA = Mental Health First Aid. OR = odd s ratio.
(--) denotes no follow -up contrast tes


  Offered basic “first
aid” and reassurance  Assisted with
seeking professional
help Confidence in
helpingb Knowledge of
referral
resourcesc
 Main effect p -value
Group contrasts (OR, 95% CI)
Agency affiliation  p = 0.35  p = 0.59  p = 0.04


Public safety/ criminal justice  -- -- -- 0.63 (0.34, 1.16)  --

SOURCE: RAND MHFA web survey, summer 2021 .
  25 NOTE: This table shows estimates of associations between agency affiliation and agency group characteristic variables and responden t


ntly
Fluent in a language
other than English  69.68%  30.74%  88.52%  68.76%  65.64%  66.42%
SOURCE: RAND MHFA web survey, summer 2021 .
a “As a result of the Mental Health First Aid training, I have  . . . ” (response range : never to frequent


ely and
compassionately
listened  Offered “first aid”
information and
reassurance  Assisted with
seeking professional
help Assisted with using
personal, peer, or
community support
 Main effect p -value
Group contrasts (OR, 95% CI)
Englis


ent at all to very confident). Dichotomized for
analysis as 1 = very confident, 0 = fairly confident, slightly confident, or not confident at all.
c “I know where I can refer individuals for help with their emotional or mental health challenges,


t some community members did not participate?
 Effectiveness
8. What aspects of MHFA have been most helpful in your community?
9. In general, do you know whether and how your community members have used their MHFA knowledge and skills? [Remind par