Legal financial obligations (LFOs) are increasingly recognized as public health exposures that can deepen poverty, destabilize housing and employment, and extend criminal legal involvement. Lindenfeld and Rouhani’s Current Issues article1 offers an important framework for incorporating fines, fees, and surcharges into public health research. This commentary extends that agenda to specialty courts, which primarily operate across Sequential Intercepts 2 (access and entry into diversion) and 3 (participation, treatment engagement, completion, and revocation risk; Table 1). Specialty courts are not merely sites where additional LFOs may be imposed; they are court-based diversion and treatment programs designed to reduce incarceration and connect participants to behavioral health care. Existing constitutional doctrine and recent state reforms already limit punishment for inability to pay and support proportionate alternatives to fines and fees. Research should therefore distinguish gross charges from net participant burden by measuring public and insurance offsets, grant support, treatment subsidies, fee waivers, timing of assessments, nonlegal participation costs, and the consequences of nonpayment. A net-burden framework can help identify when financial conditions function as harmful debt, when they are offset by public financing, and when replacing participant revenue is necessary to preserve diversion capacity while advancing equity.
Legal financial obligations in specialty courts: Measuring net burden across court-based diversion and treatment
American Journal of Preventive Medicine [Epub 2026 Oct 17]. doi: 10.1016/j.amepre.2026.108613.