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Little research exists about PTSD and traumatic experiences among justice-involved individuals with mental illnesses and how those experiences differ by race and gender. We examined traumatic experiences and PTSD among 187 individuals with serious mental illnesses on probation in the United States: 94% of participants experienced a traumatic event, rates of PTSD were highest among Black women ( p < .001), and rates of sexual assault were highest among White women ( p < .001). Justice-involved individuals with mental illnesses have complex needs and an elevated risk of PTSD and exposure to traumatic events, which has implications for probation policy and practice.

Returning citizens struggle to obtain employment after release from prison and navigating job interviews is a critical barrier they encounter. Implementing evidence-based interview training is a major gap in prison-based vocational services. We conducted a randomized controlled trial (RCT) to evaluate the feasibility and initial effectiveness of Virtual Reality Job Interview Training (VR-JIT) within two prisons. Forty-four male returning citizens were randomized to receive service-as-usual (SAU) with VR-JIT (SAU + VR-JIT, n = 28) or SAU ( n = 16). Participants reported VR-JIT was highly acceptable and usable. SAU + VR-JIT, compared with SAU, had significant improvements (with large effect sizes) in interview skills, interview training motivation, and interview anxiety (all p < .05; [Formula: see text] > .15), and greater employment by 6-month follow-up (odds ratio [OR] = 7.4, p = .045). VR-JIT can potentially help fill a major gap in prison-based services. Future research is needed to validate VR-JIT effectiveness and evaluate VR-JIT implementation strategies within prisons.

Although the research on specialty mental health probation (SMHP) is promising, there have been no randomized controlled trials (RCT) of the prototypical model advanced in the research literature and little focus on SMHP implementation. This study assesses the adoption of SMHP in two counties and examines its impact on mental health and criminal justice outcomes. Researchers conducted a RCT within a hybrid implementation-effectiveness study to examine intervention adoption as well as mental health treatment engagement and criminal justice outcomes for 100 individuals with serious mental illnesses on probation in one rural and one urban county in a southeastern state. Randomization produced equivalent treatment (n = 47) and control (n = 53) groups with no statistically significant differences between groups on demographic or background characteristics. Compared to standard probation officers, SMHP officers addressed the mental health needs of individuals with serious mental illness (i.e., adoption) at higher rates (p

BACKGROUND: Individuals with severe mental illnesses experience high rates of chronic health conditions; however, the extent to which risk of chronic physical health problems varies by race and gender among these individuals is understudied. AIMS: This study examines variations in health problems by race and gender among individuals with severe mental illnesses. METHOD: Administrative data, which included blood pressure, body mass index (BMI), and glycated hemoglobin (HbA1c) values, were obtained from 603 individuals with serious mental illnesses who received integrated health and behavioral health services from a large mental health agency in the Midwest. Bivariate and multivariate statistical models were used to examine variation in physical health problems by race and gender. RESULTS: Compared with men, women with severe mental illnesses were more likely to have BMI levels indicating obesity or morbid obesity ( p < .001). Compared with White participants, Black participants were less likely to have high HbA1c levels ( p < .001) but were more likely to have high blood pressure ( p < .001). Among race and gender groups, Black women were more likely to have high BMI ( p < .05), Black men were more likely to have high blood pressure ( p < .001), and White men were more likely to have high HbA1c levels ( p < .01) when holding constant all other variables. CONCLUSIONS: There is evidence that types and severity of physical health problems among individuals with severe mental illnesses varies by race and gender. Replication of these results and more research is needed to ensure that health-related education and integrated health and behavioral health interventions meet the needs of individuals with serious mental illnesses.

With over 4 million adults under community supervision and an average of 30% that do not fare well, an unanswered question is which strategies reduce the likelihood of technical, absconding, and new arrest violations during the early phase of supervision. Utilizing data on 32,335 moderate to high-supervised individuals on supervision in North Carolina, the study found that success during the first 6 months is due to probation officers’ use of incentives to promote positive behavior and swift community-based consequences to address negative behavior, prioritizing treatment services or cognitive programs, increasing monitoring requirements, and using skill-building worksheets to increase engagement and build rapport. Officer actions are more important than individual characteristics, and can promote success for those that are under the age of 31, have more complex needs, and are identified as at-risk for violating supervision. Future studies should explore these concepts more directly regarding their relationship with recidivism.

Assertive community treatment (ACT) is an evidence-based practice for individuals living with severe mental illnesses. Originally conceptualized as a lifetime service, there is a need for standardized measures to help ACT teams identify clients who are potentially ready for a transition to less intensive services. Here, to address this gap in the literature, the psychometric properties of the Assertive Community Treatment Transition Readiness Scale (ATR) were examined. Data on the ATR were collected from ACT staff from across the country who had experience transitioning ACT clients to less intensive services. Results from an exploratory factor analysis suggested a one-factor solution and that items on the ATR demonstrated excellent internal consistency reliability as well as predictive criterion validity and known-groups validity. The ATR is an easy-to-use, 18-item measure that has the potential, in combination with clinical judgment and practice wisdom, to be a useful tool for identifying ACT clients who could transition to a less intensive level of care.

Understanding the unique health and behavioral health needs of refugees is critical to developing culturally sensitive interventions and services for this vulnerable population. This paper highlights the process of recruiting participants for a study exploring these needs for resettled refugee women from their own perspectives and the perspectives of resettlement service providers. We recruited 14 resettled refugee women and seven service providers to participate in a semi-structured interview, which included open-ended questions and culturally-relevant vignettes designed to stimulate discussion about health and behavioral health issues. Participating women were receptive to the vignettes and were highly engaged in the study. With respect to methods, we found that it is feasible and practical to collect qualitative data using vignettes coupled with semi-structured interview questions. With respect to recruiting strategies, participants were more responsive to personal connections rather than to advertisements for recruitment. This paper reports the methodology; study results are reported separately.

Objective Justice-involved people with mental illnesses, in general, experience poor criminal justice outcomes (i.e., high rates of recidivism and probation revocations) and are at increased risk of homelessness, unemployment, stigma, trauma, and poor physical health. Low social support is repeatedly associated with worse mental health outcomes in the general population but little is known about social support among probationers with serious mental illnesses. Method To address these gaps in the literature, we used an observational cross-sectional study design and data from a large, randomized controlled trial of specialty mental health probation to examine self-reported social support and its relationships with mental health functioning and other outcomes for individuals with serious mental illnesses on supervised probation. Results Probationers who self-reported lower levels of social support also reported greater mental health symptomatology and reported lower quality relationships with their probation officers. Conclusions and implications for practice Low social support among probationers with mental illnesses has important implications for mental health and criminal justice practice and policy. Coordinating services between the criminal justice and mental health systems to offer opportunities for social support and meaningful community engagement for those with mental illnesses who are on probation could improve a number of mental health and criminal justice outcomes for this population. Peer support and supported employment services, for example, in addition to outpatient mental health services, could be two strategies that could address social isolation and help individuals living with mental illnesses optimize their recovery and rehabilitation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Purpose: A formative evaluation examined the acceptability and feasibility of tiny homes for people living with serious mental illness (SMI). Methods: The evaluation included four focus groups with people with SMI and service providers ( n = 28) and eight overnight stays with people with SMI. Results: The analysis identified six recommendations for tailoring the design of the tiny homes and the community where the homes will be located to meet the needs of people living with SMI. The recommendations for the design of the tiny homes included maximize natural light and outdoor spaces, design flexible living spaces, and ensure accessibility. The recommendations for the design of the surrounding community included ensure privacy, build a community, and maximize residents’ connectivity. Conclusions: This research serves as a starting point for interventions that aim to develop housing that is both affordable and tailored to the needs of people with SMI.

This paper presents the results of a qualitative study designed to explore and identify the resources that probation officers need to implement specialized mental health probation caseloads, a promising practice that enhances mental health treatment engagement and reduces recidivism among people with mental illnesses. Our research team conducted a directed content analysis guided by the Practical, Robust Implementation and Sustainability Model (PRISM) to analyze qualitative interviews with 16 specialty mental health probation officers and their supervising chiefs. Results indicated five components and resources related to multiple PRISM constructs: (1) meaningfully reduced caseload sizes (intervention design), (2) officers’ ability to build rapport and individualize probation (organizational staff characteristics), (3) specialized training that is offered regularly (implementation and sustainability infrastructure), (4) regular case staffing and consultation (implementation and sustainability infrastructure), and (5) communication and collaboration with community-based providers (external environment). Agencies implementing specialized mental health probation approaches should pay particular attention to selecting officers and chiefs and establishing the infrastructure to implement and sustain specialty mental health probation.

Many Assertive Community Treatment (ACT) teams transition consumers to less intensive services as the teams struggle to provide services for new clients, which is a concerning capacity-and-demand i...

Forensic assertive community treatment (FACT) is an adaptation of Assertive Community Treatment (ACT), a widely-studied evidence-based model for mental health services delivery. ACT has been demons...

Although the research on specialty mental health probation (SMHP) is promising, there have been no randomized controlled trials (RCT) of the prototypical model advanced in the research literature and little focus on SMHP implementation. This study assesses the adoption of SMHP in two counties and examines its impact on mental health and criminal justice outcomes. Researchers conducted a RCT within a hybrid implementation-effectiveness study to examine intervention adoption as well as mental health treatment engagement and criminal justice outcomes for 100 individuals with serious mental illnesses on probation in one rural and one urban county in a southeastern state. Randomization produced equivalent treatment (n = 47) and control (n = 53) groups with no statistically significant differences between groups on demographic or background characteristics. Compared to standard probation officers, SMHP officers addressed the mental health needs of individuals with serious mental illness (i.e., adoption) at higher rates (p 0.001). Compared to individuals on standard caseloads, individuals on SMHP had a higher rate of mental health engagement (e.g., mental health assessment, attending treatment appointment; p 0.050); however, more individuals on SMHP caseloads had a new crime violation during follow-up compared with individuals on standard caseloads (p 0.01). In conclusions, results suggest successful adoption of the intervention and increased mental health engagement among those on SMHP caseloads. Results are consistent with the mixed findings on the impact of SMHP on improving criminal justice outcomes.

In the United States, the number of justice-involved individuals living with mental illnesses is large and growing; however, there is little information about internalized stigma experienced by thi...

Nationally representative data on mental health disorder prevalence are critical to set informed mental health priorities and policies. Data indicating mental health diagnoses within our nation's veteran population treated at the Veterans Health Administration (VHA) are available, but have yet to be examined for changing trends to inform both VHA and community care. We use VHA national program evaluation data from a time of increasing military enrollment (2007) to troop draw down (2013) to examine changes over time in the number of diagnoses in veterans receiving VHA services. The number of veterans in all diagnostic categories increased during our study period with the smallest increase in psychotic disorders (8%) and the largest in posttraumatic stress disorder (71%). Trends in behavioral health diagnoses among veterans have important implications for policy and clinician competencies within VHA and community providers as veteran mental health care needs change.

Adults released from incarceration are at high risk of death from drug-related causes, pointing to the importance of connecting individuals to healthcare services after release from prison. Though Medicaid plays an important role in financing behavioral health treatments for vulnerable groups, many states terminate individuals' Medicaid coverage during incarceration. A significant risk factor for substance use disorders (SUD) among incarcerated individuals is serious mental illness (SMI). In January 2006, Washington State began a program of expedited Medicaid enrollment for individuals with mental illnesses being discharged from state prisons, jails, and psychiatric hospitals. Prior literature has shown this program to be effective in increasing Medicaid enrollment and use of mental health services for people with SMI. The current paper examined the effect of referral to expedited Medicaid on use of SUD treatment for people with SMI released from prison. Our sample consisted of 3086 individuals with a diagnosis of SMI who were released from prison from January 1, 2006 to December 31, 2007. Of the sample we identified, 871 individuals received referrals for expedited Medicaid and 2215 did not. To control for selection bias on observed characteristics for referral, we used inverse probability weights (IPW) to balance the referred and not-referred groups on more than 50 baseline covariates. We used doubly-robust IPW models to estimate the effect of referral to expedited Medicaid on use of SUD treatments following prison release. Approximately 12% of our sample used any SUD treatment by 3 months after release, with this percentage rising to 28% at 12 months. When controlling for baseline differences, referral to expedited Medicaid enrollment was associated on average with a 6.7 (SE 2.9, p .05) percentage point increase in the predicted probability of using any SUD treatment in the 3 months following release as compared to those not referred to the program. This effect size represents a 61% increase in the probability of using any treatment by 3 months. The result was similar for the 6-month follow-up period and persisted at the 12-month follow-up though the magnitude of the effect decreased somewhat. Overall, our results suggest that expedited Medicaid enrollment for people with SMI released from prison can increase use of SUD services.

This article reports the findings of a 2-day public health social work (PHSW) summit that brought together PHSW educators, practitioners, and administrators to generate ideas for preparing the next generation of PHSW leaders. Data from focus groups revealed four themes: the importance of PHSW in our healthcare delivery system, the need for public health social workers to develop their professional identity, the significance of branding/promoting PHSW, and the favorable consequences of infusing PHSW content into social work curricula. Attendees generated ideas for bringing PHSW forward and provided recommendations to accrediting bodies for highlighting the importance of PHSW.

Objectives Describe to what extent case workers identify their professional role as behavioral health care managers, and variation based on individual characteristics. Method We used data from the 2008–2011 National Survey of Child and Adolescent Well-Being II to describe child welfare case workers' perceived responsibility for the care management of children on their caseloads who were prescribed medications for behavioral health needs. Results Most caseworkers (80%) felt very responsible for the behavioral health management of children. There was variation across five management activities: most reported feeling very responsible for documenting medication use in child welfare records (66%), and over a third (34%) for arranging evaluation or treatment visits for the child (34%). Perceived responsibility varied by age, experience and education. Conclusions Caseworkers increasingly serve as behavioral health care managers, and brokers to other systems such as courts. Ongoing training is needed to support their ability to meet these demands.

BACKGROUND The large and growing number of individuals with severe mental illnesses who are on probation presents challenges to both mental health and criminal justice authorities. The clinical and mental health service needs of probationers with severe mental illnesses have however, been insufficiently researched, particularly with respect to trauma and the need for trauma-informed services. AIMS To explore the lifetime prevalence of post-traumatic stress disorder (PTSD) among people on probation who also have other serious mental illnesses and their demographic characteristics. METHODS Individuals on probation in six counties in one southeastern state who had been diagnosed with severe mental illnesses were assessed for PTSD; they were also asked whether they had experienced any of 14 traumatic events of interest over their lifetimes. RESULTS Of 207 participants, about half had clinically diagnosable PTSD. Nearly two-thirds had experienced more than five traumatic events during their lifetimes: 86% experienced at least one non-interpersonal traumatic event, such as a car accident, and 90% experienced at least one interpersonal traumatic event, such as a physical assault. The latter was the single most frequently reported traumatic event (80%, n = 160). PTSD was, on average, associated with a higher number of prior traumatic experiences overall. CONCLUSIONS In one state in the USA, rates of trauma experiences and PTSD among probationers with other mental illnesses are high. Relative to prisoners, little is known about the mental health needs among probationers, so replication in a larger sample across jurisdictions would be useful. Findings are likely to have implications for form of service delivery as well as treatment needs.

Assertive community treatment (ACT) is an evidence-based practice for individuals living with severe mental illnesses. Originally conceptualized as a lifetime service, there is a need for standardized measures to help ACT teams identify clients who are potentially ready for a transition to less intensive services. Here, to address this gap in the literature, the psychometric properties of the Assertive Community Treatment Transition Readiness Scale (ATR) were examined. Data on the ATR were collected from ACT staff from across the country who had experience transitioning ACT clients to less intensive services. Results from an exploratory factor analysis suggested a one-factor solution and that items on the ATR demonstrated excellent internal consistency reliability as well as predictive criterion validity and known-groups validity. The ATR is an easy-to-use, 18-item measure that has the potential, in combination with clinical judgment and practice wisdom, to be a useful tool for identifying ACT clients who could transition to a less intensive level of care.

The inclusion of indirect spillover costs and benefits that occur in non-healthcare sectors of society is necessary to make optimal societal decisions when assessing the cost effectiveness of healthcare interventions. Education costs and benefits are relevant in the disease area of mental and behavioral disorders, but their inclusion in economic evaluations is largely neglected due to lack of methodological knowledge.This study aims to explore, using a scoping review, the identification, measurement, and valuation methods used to assess the impact of mental and behavioural disorders on education costs and benefits.A scoping review was conducted to identify articles that were set in the education sector and assessed education costs and benefits. An adapted 5-step approach was used: (i) initating a scoping review; (ii) identifying component studies; (iii) data extraction; (iv) reporting results; (v) discussion and interpretation of findings. Results were summarized in a narrative synthesis per identification, measurement, and valuation method.177 component articles were identified in the scoping review that reported 61 mutually exclusive education costs and benefits. The nomenclature used to describe the costs and benefits was poorly defined, heterogeneous in nature and largely context dependent. This was also reflected in the diverse number of measurement and valuation methods found in the component articles.This is the first study, which offers a classification of education costs and benefits and costing methods reported by studies set in the education sector. In conclusion, mental and behavioral disorders have a notable impact on a variety of different education costs and benefits.The classification provided in the current study gives an indication of the wide-spread impact of mental and behavioral disorders on the education sector. Hence, the inclusion of relevant education costs and benefits in economic evaluations for mental and behavioral disorders is necessary to make optimal societal decisions.By exploring a new area of research from a sector-specific perspective, the current study adds to the existing intersectoral cost and benefit literature base. Future research should focus on standardizing costing methods in pharmacoeconomic guidelines and assessing the relative importance of individual education costs and benefits in economic evaluations for specific interventions and diseases.

As compared with the general population, women with serious mental illness experience higher rates of intimate partner violence, sexual assault, and are at a greater risk of future victimization, post-traumatic stress disorder, exacerbated symptoms of mental illness, and other negative health outcomes. Despite substantial research, the field lacks clear, consistent guidance for intervention development. To this end, this review aims to move the field beyond its focus on prevalence by providing a comprehensive and concise summary that compares and assesses the findings, quality, and scope of 10 systematic reviews (reviewing 168 studies) pertaining to prevalence and risk factors of intimate partner violence and/or sexual assault among women with serious mental illness.

This study examined long-term outcomes (at 36 months) from Washington State's policy of expediting Medicaid enrollment for prison releasees with severe mental illness and compares them with previously reported short-term outcomes (at 12 months).Linked administrative data on prison releasees (2006-2007) were analyzed by using a quasi-experimental design comparing those referred to expedited Medicaid (N=895) with a control group of those not referred (N=2,189). Aggregate outcomes were analyzed with inverse probability of treatment-weighted logit models.Expedited Medicaid had a sustained effect on both increased months of enrollment (p.01) and increased use of community mental health and general medical services (p.01) 36 months after prison release. However, expedited Medicaid did not reduce criminal recidivism, consistent with 12-month findings, Conclusions: Outcome results at 12 months were sustained at 36 months-namely, expedited Medicaid for released prisoners with severe mental illness improved enrollment and service use with no effects on criminal recidivism.

An emerging focus of Assertive Community Treatment (ACT) teams is the transition of clients to less intensive services, which creates space for individuals in need of ACT and is consistent with a recovery orientation of treatment. However, there is limited research on team transition rates, post-ACT services, and strategies to overcome transition barriers. In addition, few studies have examined differences in these factors among urban and rural ACT teams. To address these knowledge gaps, we interviewed eight ACT teams in urban and rural areas of eastern Ontario regarding their transition rates, processes of transitioning ACT clients to less intensive services, transition barriers, and solutions to overcoming these barriers. On average, teams transitioned about 6% of their clients over our 3-year study period. Urban and rural teams described both similar and distinct clinical and systemic barriers, such as client reluctance to transition and finding psychiatric follow-up outside of ACT. Implications for ACT practice and policy are discussed.

As part of a larger study of probation workload and workforce challenges in one southeastern state, this study reports the results from a statewide survey of probation officers’ experiences supervising probationers with mental illness. A total of 615 officers responded to closed- and open-ended questions about the challenges and barriers to supervising offenders with mental illness, and the responses of officers from rural versus urban settings were compared. Officers reported that probationers with mental illness are difficult to supervise and supervision challenges are exacerbated by a scarcity of mental health and substance abuse treatment resources, limited social support, and a lack of employment opportunities for this population of probationers. Officers report unique and similar challenges across rural and urban settings. This study contributes to our understanding of the challenges of supervising probationers with mental illness and informs practice, policy and research at the interface of the criminal justice and mental health systems.

Alternative payment models, including Accountable Care Organizations and fully capitated models, change incentives for treatment over fee-for-service models and are widely used in a variety of settings. The level of payment may affect the assignment to a payment category, but to date the upcoding literature has been motivated largely incorporating financial penalties for upcoding rather than by a theoretical model that incorporates the downstream effects of upcoding on service provision requirements.In this paper, we contribute to the literature on upcoding by developing a new theoretical model that is applicable to capitated, case-rate and shared savings payment systems. This model incorporates the downstream effects of upcoding on service provision requirements rather than just the avoidance of penalties. This difference is important especially for shared-savings models with quality benchmarks.We test implications of our theoretical model on changes in severity determination and service use associated with changes in case-rate payments in a publicly-funded mental health care system. We model provider-assigned severity categories as a function of risk-adjusted capitated payments using conditional logit regressions and counts of service days per month using negative binomial models.We find that severity determination is only weakly associated with the payment rate, with relatively small upcoding effects, but that level of use shows a greater degree of association.These results are consistent with our theoretical predictions where the marginal utility of savings or profit is small, as would be expected from public sector agencies. Upcoding did seem to occur, but at very small levels and may have been mitigated after the county and providers had some experience with the new system. The association between the payment levels and the number of service days in a month, however, was significant in the first period, and potentially at a clinically important level. Limitations include data from a single county/multiple provider system and potential unmeasured confounding during the post-implementation period.Providers in our data were not at risk for inpatient services but decreases in use of outpatient services associated with rate decreases may lead to further increases in inpatient use and therefore expenditures over time.Health program directors and policy makers need to be acutely aware of the interplay between provider payments and patient care and eventual health and mental health outcomes.Further research could examine the implications of the theoretical model of upcoding in other payment systems, estimate the power of the tiered-risk systems, and examine their influence on clinical outcomes.

Little is known about the job satisfaction of licensed clinical social workers (LCSWs) participating in the National Health Service Corps (NHSC) federal Loan Repayment Program (LRP). Employee satisfaction in organizations is important for organizational well-being and to decrease turnover. A satisfied NHSC LCSW workforce is also important given the array of services it provides, especially in rural and underserved areas. This study examined the work satisfaction of 386 LCSWs participating in the NHSC LRP in 21 states. Rural upbringing, being older than 40 years, and a higher salary were significantly associated with overall work and practice satisfaction. In addition, satisfaction with administration, staff and the practices’ linkages to other health providers, the mission of the practice, and connection with patients were strongly associated with overall work and practice satisfaction. To our knowledge, this is the first study to examine the work and practice satisfaction of LCSWs participating in the NHSC LRP, and our findings have the potential to inform the NHSC’s strategies in managing and retaining LCSWs.

Individuals who have committed sex offenses (ISOs) with severe mental illnesses are a complex population to serve and more research is needed to guide practice and policy, especially around community supervision, enrollment in Medicaid, housing, employment, criminal justice contacts, and reincarceration after prison reentry. To further the literature in this area, we used logistic regression to model recidivism and admissions to violator or prison facilities among 127 ISOs with severe mental illnesses and 2,935 people with severe mental illnesses who were incarcerated in prison for other crimes. Compared to prison releasees with severe mental illnesses who committed crimes other than sex offenses, prison releasees with severe mental illnesses who committed sex offenses were admitted to violator facilities at higher rates, when controlling for substance use, Medicaid enrollment, homelessness, and unemployment. Implications for practice, policy and research are discussed.

Objective To examine whether the receipt of timely mental health services is associated with changes in criminal justice interactions. Data sources We used linked administrative data from Medicaid, mental health, and criminal justice settings in Washington State for persons with severe mental illness released from prison (n = 3086). Study design We estimate local and average treatment effects to examine measures of criminal justice use in the year following release as a function of timely mental health services. Data extraction methods Measures of timely service and criminal justice use within 12 months postrelease were created from administrative data. Principal findings Individuals receiving timely mental health services are more likely to experience prison re-incarceration overall and specifically for technical violations 12 months postrelease. The effect of service receipt on incarceration for new charges was negative but not significant. Conclusions The finding that mental health services receipt is associated with increased risk of re-incarceration due to technical violations speaks to the complexity of the relationship between mental health and criminal justice services for justice-involved persons with severe mental illness. Further research should examine strategies at the interface of criminal justice and mental health that can improve mental health and criminal justice outcomes for this vulnerable population.

We sought to explore clinical factors associated with successful transition from Assertive Community Treatment to less intensive clinical services. Mixed-method observational follow up study of veterans discharged from three VA-affiliated ACT teams to less intensive clinical services. Of the 240 veterans in ACT, 9% (n = 21) were discharged during the study period. Among the 11 of 21 discharged veterans who enrolled in the follow up study, reason for discharge, designated by the veteran's primary clinician at the time of discharge, predicted outcomes (p = 0.02) at 9 months, with "disengagement" as a reason for discharge predicting poorer outcomes. Six of 11 veterans experienced poor outcomes at 9 months, including incarceration and substance use relapse. ACT clinicians rarely discharge clients. Many clients may experience negative clinical events following ACT discharge, and clients may be difficult to follow post-discharge. Client disengagement from ACT may indicate higher likelihood of poor outcomes following discharge to less intensive clinical services.

More information is needed about the financial experiences of justice-involved persons with severe mental illness. Qualitative and quantitative methods were used to examine the financial resources,...

Objective:This study examined postrelease patterns of Medicaid coverage and use of services among persons with severe mental illness who were referred for expedited Medicaid enrollment before their release from state prisons, county jails, and psychiatric hospitals in Washington State during 2006, the first year of a new policy authorizing this practice.Methods:A retrospective cohort design was used with linked administrative data to identify persons with severe mental illness (schizophrenia, bipolar disorder, or major depression) who were referred for expedited Medicaid enrollment from state prisons (N=252), county jails (N=489), and psychiatric hospitals (N=507). For each cohort, logistic regression was used to compare those who were approved for expedited Medicaid with those who were not approved; for the 30-, 60-, and 90-day periods after release, Medicaid enrollment status and use of outpatient mental health services were also compared.Results:Approval rates were higher for persons released from psyc...

TOPIC Although individuals with medical problems (e.g., diabetes, hypertension) can monitor their symptoms using objective measures (e.g., blood glucose, blood pressure), objective measures are not typically used by individuals with psychotic disorders to monitor symptoms of mental illness. PURPOSE To examine the benefits and limitations of the use of video self-observation for treatment of individuals with psychotic disorders. SOURCES USED The authors reviewed studies examining video self-observation among individuals with severe mental illnesses. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Individuals with psychotic disorders who viewed videos of themselves while symptomatic reported some benefit to this approach, with 1 study showing sustained improvement in understanding of mental illness. Still, some individuals reported negative feelings about the process, and also attributed symptoms to stress or drug abuse rather than their psychotic disorder. The authors found no studies examining the potential for video self-observation as a strategy to improve clinical decision-making in the context of mental health care. Implications of this approach for mental health recovery and clinical practice are discussed. (PsycINFO Database Record

OBJECTIVE With nearly 11 million people in the United States arrested in 2015, the need to identify antecedent risk factors driving criminal justice involvement (CJI) and possible mitigating factors is crucial. This study examines the relation between childhood trauma and CJI in adolescence and adulthood and assesses how this relation is moderated by mentoring during young adulthood. METHODS The analysis included 3 waves of data-adolescents, young adults, and adults-collected from 1995 to 2008 from 12,288 adolescents who participated in the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adolescents in grades 7 to 12. Logistic regression was used to examine how having a close mentor in adolescence moderated the relation between criminal justice involvement and 9 childhood traumatic events: (1) neglect, (2) emotional abuse, (3) physical abuse, (4) sexual abuse, (5) parental incarceration, (6) parental binge drinking, (7) witnessed violence, (8) threatened with violence, and (9) experienced violence. RESULTS Cumulative exposure to childhood trauma was associated with CJI in adolescence (adjusted odds ratios [AORs] ranging from 2.24 to 25.98) and adulthood (AOR range, 1.82-6.69), and parental incarceration was consistently one of the, if not the, most strongly associated with each form of CJI; the strength of these associations was weakened for those who reported a close mentor compared to those who did not. CONCLUSIONS This study advances the literature regarding trauma and CJI, highlighting the role of social support and mentorship as protective factors for youth who experience childhood trauma. Interventions aimed at protecting vulnerable children from the harms of trauma should be the next priority.

There is little published information about the measures that probation agencies in the United States use to identify individuals with mental illnesses who are under community supervision. This study used statewide administrative data to estimate and compare the prevalence of mental illnesses among probationers using officer report and offender self-report data. Prevalence estimates of mental illnesses ranged from 15 percent to 19 percent, which is consistent with prior studies that used formal diagnostic assessments. In the absence of costly and time-consuming diagnostic assessments, probation agency-developed mental health scales can aid in identifying those who might be in need of additional mental health assessment.

Women with severe mental illnesses face high rates of violence victimization, yet little is understood about the unique needs and challenges these women present to the domestic violence and behavioral health agencies that serve them. To help address this knowledge gap, focus groups were conducted with 28 staff members from local behavioral health and domestic violence service agencies. Results from this exploratory study suggest that women with severe mental illnesses who experience intimate partner violence face additional challenges that exacerbate behavioral health and domestic violence issues and put these women at greater risk for continued victimization. DV and behavioral health agency staff experience individual-, provider-, and system-level barriers to serving this high-risk, high-need population. Recommendations and implications for domestic violence and behavioral health providers are discussed.

A previous study of a recovery-oriented assertive community treatment initiative (PACT) in Washington State found reductions in state psychiatric hospital use and related costs for PACT participants, especially in the first six months after enrollment and for consumers who were high users of the state psychiatric hospital before ACT enrollment. This study examined whether these outcomes varied by team fidelity to recovery-oriented ACT practices.Generalized estimating equations (GEE) were used to examine the relationship between scores on the Tool for Measurement of Assertive Community Treatment (TMACT), a recently developed tool for assessing fidelity to recovery-oriented ACT, and the use of state hospitals, local hospitals, emergency departments, local crisis stabilization units, and arrests for 631 PACT consumers. These relationships were also examined for PACT consumers with any state hospital use (N=450) and those considered high users of the state hospital (≥ 96 days in two years before PACT enrollment).TMACT scores were associated (p.01) with a decrease in the amount of use but not the probability of using state psychiatric hospitals, local hospital psychiatric inpatient units, and local crisis stabilization units. The marginal effects of higher TMACT scores on the probability and use of emergency departments or arrests were not statistically significant.This study provides preliminary evidence for the predictive validity of the TMACT. Future research should examine the subscale structure of the TMACT as well as the association between TMACT fidelity and consumer well-being, quality of life, and other important person-centered outcomes.

There are more than 2,500 Crisis Intervention Teams (CIT) in operation across the country. Results of research on the effectiveness and impact of CIT are mixed. One aspect of CIT training that has yet to be examined is the expert-derived suggestion that 40 consecutive hours of training is an essential element of CIT for law enforcement officers. That is, CIT training is delivered in one 40-hour week, but it is unclear whether the training could be delivered in segments and still achieve its desired outcomes. Segmented training could make CIT more accessible to smaller, particularly rural, law enforcement agencies. Can segmented CIT achieve outcomes similar to those of traditional CIT training? We compared the knowledge and attitudes of 47 police officers who received traditional CIT training and 32 officers who received segmented CIT training. Our findings suggest that segmented CIT training and traditional CIT training produce comparable results regarding officers' knowledge of mental illness and attitudes toward persons with mental illness, providing preliminary support for this adaptation to the delivery of CIT training.

Large urban jails have become a collection point for many persons with severe mental illness. Connections between jail and community mental health services are needed to assure in-jail care and to promote successful community living following release. This paper addresses this issue for 2855 individuals with severe mental illness who received community mental health services prior to jail detention in King County (Seattle), Washington over a 5-year time period using a unique linked administrative data source. Logistic regression was used to determine the probability that a detainee with severe mental illness received mental health services while in jail as a function of demographic and clinical characteristics. Overall, 70 % of persons with severe mental illness did receive in-jail mental health treatment. Small, but statistically significant sex and race differences were observed in who received treatment in the jail psychiatric unit or from the jail infirmary. Findings confirm the jail's central role in mental health treatment and emphasize the need for greater information sharing and collaboration with community mental health agencies to minimize jail use and to facilitate successful community reentry for detainees with severe mental illness.

Evidence-based practice must include the translation of research into practice, and the social work practitioner is the essential link in that translation. As part of the EBP process, researchers must present findings in a way that is accessible to practitioners and practitioners must view the study as relevant and representative of their clients’ needs. This article provides practitioners with tools to interpret research, specifically the sampling process. Our goal is to support practitioners in bridging the gap between research and practice. We discuss how sampling fits with the translation of research and describe sampling procedures. We conclude with a unique three-step approach for reviewing research that is designed to assist practitioners to translate research into practice.

Despite the high prevalence of substance use disorders (SUDs) in the U.S., many with a SUD go untreated and/or report lengthy delays to help-seeking initiation. From a public health standpoint, because SUDs often emerge in early adulthood, information on help-seeking behaviors among young adults is important. Using data from young adults ages 18-23 years with a history of a SUD (n = 672) in Miami-Dade County, Florida, this study estimates the prevalence of lifetime help-seeking initiation and examines factors related to help seeking and delays to help-seeking initiation. The majority (68%) of young adults with a history of a SUD reported never having sought help, and those who reported help seeking experienced relatively lengthy delays (1-7 years) to help-seeking initiation. These findings underscore the need for both timely substance abuse treatment and for accelerated research on successful outreach strategies for young adults with SUDs.

PURPOSE: Forensic assertive community treatment (FACT) is a recent adaptation of the assertive community treatment (ACT) model; however, more information is needed about how FACT and ACT consumers differ and how FACT should be modified to accommodate these differences. METHOD: Linked, multisystem administrative data from King County, Washington, were used to compare the demographic, clinical, and criminal justice characteristics of ACT- and FACT-eligible consumers. RESULTS: FACT consumers were more likely to be male, persons of color, and had more complex clinical profiles. Also, some FACT consumers were incarcerated for sex offenses, and more than half had violent offenses. CONCLUSIONS: Traditionally, ACT teams avoid serving consumers with personality disorders, violent consumers, and sex offenders; however, given increased use of mandated outpatient treatment and mental health courts, FACT teams may have less discretion to choose whom they serve. The addition of clinical interventions and other modifications may be particularly important for FACT teams.

BACKGROUND: Assertive community treatment (ACT) is characterized as a service delivery platform and represents an ideal setting in which mental health and physical health care can be integrated. OBJECTIVE: Little is known about the extent to which ACT integrates physical health care with mental health care or the challenges ACT teams experience. To address this gap, focus groups were conducted with five ACT teams in a Midwestern US state to explore how ACT teams address the physical health care needs of persons with severe mental illness. DESIGN: A qualitative study design was used. RESULTS: Three major themes emerged: ACT teams recognize serious and chronic physical health problems, ACT teams take on a variety of roles to address physical health problems, and there are challenges to integrating primary and mental health care within an ACT setting. CONCLUSIONS: ACT needs to be adapted to incorporate promising practices designed to better integrate physical health care and mental health care.

At-risk adolescents experience troubling levels of depression but there is a dearth of research related to the levels of depression and associated psychosocial problems experienced by adolescent abortion patients. The relationship between depression and 16 other psychosocial life problems is examined in a sample of adolescent pregnancy termination patients. Using the Multidimensional Adolescent Assessment Scale (MAAS), depression and related psychosocial problems are assessed in a sample of 120 U.S. abortion patients ages 14–21. In general, patients scoring above the clinical cutscore for depression also reported higher levels of psychosocial problems in the other areas. Depression was significantly associated with problems with self-esteem, stress, guilt and confused thinking. Implications for practice and research are discussed.

Individuals with severe mental illnesses (SMI) are a vulnerable population, struggling to cope with fragmented and often unwelcoming community service systems. Research has examined Assertive Community Treatment (ACT) as an intervention for SMI individuals, but little research has explored ACT's potential as a community system change intervention. Using focus groups with ACT teams, we explored changes in community service systems as a result of ACT teams' presence. Changes identified included increased understanding of SMI; increased access to services; and increased collaboration across service systems. Processes by which these changes occurred included knowledge communication, negotiation, renaming by association, and ongoing relationships.

Persons with severe mental illness have higher rates of chronic general medical illness compared with the general population. Similarly, compared with the general population, incarcerated persons have higher rates of chronic medical illness; however, there is little information about the synergy between severe mental illness and incarceration and the general medical problems of consumers. To address this gap in the literature this study addressed the following question: are consumers with a history of incarceration at greater risk of general medical problems compared with consumers without such a history?Administrative data were used to compare the medical problems of 3,690 persons with severe mental illness with a history of incarceration and 2,042 persons with severe mental illness with no such history.Consumers with a history of incarceration were more likely than those with no such history to have infectious, blood, and skin diseases and a history of injury. Furthermore, when analyses controlled for gender, race, age, and substance use disorders, consumers with an incarceration history were 40% more likely to have any general medical problem and 30% more likely to have multiple medical problems.The findings presented here call for better communication among local public health and mental health providers and jails and better integration of primary care and behavioral health care among community mental health providers. Also, research should be accelerated on evidence-based interventions designed to divert persons with severe mental illness from the criminal justice system and facilitate community reentry for persons with severe mental illness who are released from jails and prisons.