An Economic Analysis of the Cost of a Regional Crisis Stabilization Unit.

Crisis stabilization units (CSUs) are one type of "alternative to arrest" program used for jail diversion. We aimed to estimate the economic costs of starting and operating a CSU in Arkansas. We estimated the economic costs of the Pulaski County Regional CSU (PCRCSU) located in Little Rock, Arkansas, from September 1, 2018, to August 31, 2019. We collected data through interviews about start-up and ongoing management costs. We calculated total annual economic cost, average admission cost, and average 24 hr admission cost. There were 536 admissions to the CSU during the study period. The average length of stay was 60.27 hr. The total annual cost of the PCRCSU was $1,636,831 and average per admission cost was $3,054. Our results provide valuable economic data to government stakeholders who are considering establishing a CSU.

Wildlife must be protected from crime and trade for the sake of public and planetary health.

COVID-19 most likely had its origins in wildlife, and hundreds of thousands of new viruses could spill over from wildlife to humans. We are struggling to combat climate change, and we are staring down the loss of a million species. It's time to change course.

Perceptions of legal legitimacy in veterans treatment courts: A test of a modified version of procedural justice theory.

OBJECTIVE: Perceptions of the legitimacy of a society's legal system help explain individual responses to courts and legal actors. Normative considerations such as fair and respectful treatment as well as social identification have demonstrated the ability to enhance perceived legal legitimacy and future cooperation. Veterans treatment courts (VTCs) are a rapidly disseminating and understudied intervention. Their targeting of a socially esteemed group presents an interesting venue to explore normative theories of justice. The present study tested a modified version of Tyler's theory of procedural justice in this setting. HYPOTHESES: We hypothesized that procedural justice, social bonds, and receipt of gratitude for military service would be positively associated with veteran identity and legal legitimacy. We further hypothesized that participants' identification as veterans would mediate the relationships between the three independent variables and legitimacy. METHOD: A cross-sectional survey design was used with a convenience sample (N = 191) of participants in two VTCs. Analyses controlled for race, ethnicity, recidivism risk, and combat exposure. RESULTS: Perceptions of procedural justice, social bonds, and receipt of gratitude were positively associated with veteran identity and perceptions of legal legitimacy. Further, veteran identity was found to be a significant mediator between the first three constructs and legal legitimacy. CONCLUSIONS: The results support the importance of procedural justice in explaining perceptions of legal legitimacy in a novel context that is rapidly proliferating and understudied and has unique social identity considerations. The addition of gratitude and veteran identity to Tyler's model raises implications for VTC practice and further inquiry. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A quasi-experimental study of the Multi-Agency Investigation & Support Team (MIST): A collaborative response to child sexual abuse.

To improve the holistic response to child sexual abuse in Perth, Western Australia, a group consisting of government and community support agencies developed a new co-located approach that combined support services with investigations, called the Multi-agency Investigation & Support Team (MIST). The model was comparable to the prominent Children's Advocacy Centre approach, with adaptations for Australian conditions. This study evaluated the fidelity with which this new program was delivered and examined whether it resulted in improved criminal justice, child protection, and service outcomes compared to existing practice. Drawing on service data linked across participating agencies the study found MIST was delivered with reasonable fidelity to its planned procedure, but with some challenges for delivery of the program due to the relative workload for staff in the MIST condition. The service demonstrated high levels of caregiver satisfaction with the response and high rates of children's engagement with therapy. A quasi-experimental comparison between MIST (n = 126) and Practice as Usual (n = 276) found MIST was significantly faster throughout the criminal justice and child protection processes, but the conditions did not differ in the rate of arrest or child protection actions. While embedding support services within the investigation process may not have a dramatic influence on criminal justice and child protection outcomes, the high rates of uptake of therapeutic services and parental satisfaction suggest other benefits that require future exploration.

Expanding Therapeutic Jurisprudence Across the Federal Judiciary.

A patchwork of drug courts and other problem-solving courts currently exists to divert individuals with mental illness and substance use disorders away from the criminal justice system. We call for a broader implementation of problem-solving courts, particularly at the federal level, that would operate according to the principles of therapeutic jurisprudence (i.e., a framework that aims to maximize the health benefits of judicial and legislative policies and practices). Expanding federal problem-solving courts will better serve individuals with mental illness and substance use disorders in the federal criminal justice system and allow them to benefit from rehabilitation and diversion programs. This effort will also signal that the federal judiciary has recognized the criminal justice system's failure to address inmate mental health care, and that it is willing to institute changes to provide appropriate, evidence-based interventions.

Arrest and emergency medical services events among participants from one of the first mental health courts.

OBJECTIVE: This study looked at, in addition to subsequent arrest, emergency medical services (EMS) events as an outcome of participation in mental health court (MHC). METHODS: We linked information from participants of a MHC in Marion County, Indiana with jail booking and EMS services data. To understand programmatic impact, we looked at differences in jail bookings and EMS events within one year prior to and one year after MHC participation. We ran paired t-tests to understand whether correlations were significant. We also considered differences in outcomes between those who successfully completed MHC versus those who did not. RESULTS: MHC participation was significantly associated with a reduction in jail bookings and EMS events in the 12 months after program participation compared to the 12 months before. When comparing MHC participant groups, a significant reduction in jail bookings is found consistently whereas a significant reduction in EMS events was found in only some participant groups: the entire MHC group and the misdemeanor-level court (PAIR) participants when they successfully completed the program. CONCLUSIONS: EMS utilization should be an outcome of consideration in evaluating the success and cost savings of MHCs. Where MHCs do not result in significantly reduced EMS events, communities should consider what individual-level and community-level factors contribute to this and adjust accordingly.

Organizational structure, climate, and collaboration between juvenile justice and community mental health centers: implications for evidence-based practice implementation for adolescent substance use disorder treatment.

BACKGROUND: Substance use disorders are prevalent among youth involved with the criminal justice system, however, evidence-based substance use disorder treatment is often unavailable to this population. The goal of this study was to identify barriers to effective implementation of evidence-based practices among juvenile justice and community mental health organizations through the lens of an adopter-based innovation model. METHODS: In this mixed-methods study, qualitative interviews were conducted with n = 15 juvenile justice staff and n = 14 community mental health staff from two counties implementing substance use services for justice involved youth. In addition, n = 28 juvenile justice staff and n = 85 community mental health center staff also completed quantitative measures of organizational effectiveness including the implementation leadership scale (ILS), organizational readiness for change (ORIC), and the implementation climate scale (ICS). RESULTS: Organizationally, staff from community mental health centers reported more "red tape" and formalized procedures around daily processes, while many juvenile justice staff reported a high degree of autonomy. Community mental health respondents also reported broad concern about their capacity for providing new interventions. Staff across the two different organizations expressed support for evidence-based practices, agreed with the importance of treating substance use disorders in this population, and were enthusiastic about implementing the interventions. CONCLUSIONS: While both community mental health and juvenile justice staff express commitment to implementing evidence-based practices, systems-level changes are needed to increase capacity for providing evidence-based services.

Prospective study of mental health court and life satisfaction.

Many communities have created specialized mental health courts (MHCs) to reduce unnecessary criminal justice involvement of persons with mental disorders. Although MHCs have shown favorable public safety outcomes, such as reducing risk for criminal recidivism and violent behavior, there has been little study of issues important to consumers, such as life satisfaction. This study prospectively evaluated the association between MHC participation and life satisfaction using data from 140 participants in a quasi-experimental research project on the San Francisco MHC. A fixed-effects regression model was used to examine whether MHC involvement predicted life satisfaction at 6-month follow-up while controlling for baseline life satisfaction, age, gender, and schizophrenia diagnosis. MHC involvement, baseline life satisfaction, and schizophrenia diagnosis significantly predicted life satisfaction at 6-months. Although the public safety benefits of MHCs are important, the present study also shows the potential for MHC to enhance important outcomes such as life satisfaction.

Risk factors for self-harm in prison: a systematic review and meta-analysis.

BACKGROUND: Self-harm is a leading cause of morbidity in prisoners. Although a wide range of risk factors for self-harm in prisoners has been identified, the strength and consistency of effect sizes is uncertain. We aimed to synthesise evidence and assess the risk factors associated with self-harm inside prison. METHODS: In this systematic review and meta-analysis, we searched four electronic databases (PubMed, Embase, Web of Science, and PsycINFO) for observational studies on risk factors for self-harm in prisoners published from database inception to Oct 31, 2019, supplemented through correspondence with authors of studies. We included primary studies involving adults sampled from general prison populations who self-harmed in prison and a comparison group without self-harm in prison. We excluded studies with qualitative or ecological designs, those that reported on lifetime measures of self-harm or on selected samples of prisoners, and those with a comparison group that was not appropriate or not based on general prison populations. Data were extracted from the articles and requested from study authors. Our primary outcome was the risk of self-harm for risk factors in prisoners. We pooled effect sizes as odds ratios (OR) using random effects models for each risk factor examined in at least three distinct samples. We assessed study quality on the basis of the Newcastle-Ottawa Scale and examined between-study heterogeneity. The study protocol was registered with PROSPERO, CRD42018087915. FINDINGS: We identified 35 independent studies from 20 countries comprising a total of 663 735 prisoners, of whom 24 978 (3·8%) had self-harmed in prison. Across the 40 risk factors examined, the strongest associations with self-harm in prison were found for suicide-related antecedents, including current or recent suicidal ideation (OR 13·8, 95% CI 8·6-22·1; I2=49%), lifetime history of suicidal ideation (8·9, 6·1-13·0; I2=56%), and previous self-harm (6·6, 5·3-8·3; I2=55%). Any current psychiatric diagnosis was also strongly associated with self-harm (8·1, 7·0-9·4; I2=0%), particularly major depression (9·3, 2·9-29·5; I2=91%) and borderline personality disorder (9·2, 3·7-22·5; I2=81%). Prison-specific environmental risk factors for self-harm included solitary confinement (5·6, 2·7-11·6; I2=98%), disciplinary infractions (3·5, 1·2-9·7; I2=99%), and experiencing sexual or physical victimisation while in prison (3·2, 2·1-4·8; I2=44%). Sociodemographic (OR range 1·5-2·5) and criminological (1·8-2·3) factors were only modestly associated with self-harm in prison. We did not find clear evidence of publication bias. INTERPRETATION: The wide range of risk factors across clinical and custody-related domains underscores the need for a comprehensive, prison-wide approach towards preventing self-harm in prison. This approach should incorporate both population and targeted strategies, with multiagency collaboration between the services for mental health, social care, and criminal justice having a key role. FUNDING: Wellcome Trust.

Predictive Modeling of Opioid Overdose Using Linked Statewide Medical and Criminal Justice Data.

Importance: Responding to the opioid crisis requires tools to identify individuals at risk of overdose. Given the expansion of illicit opioid deaths, it is essential to consider risk factors across multiple service systems. Objective: To develop a predictive risk model to identify opioid overdose using linked clinical and criminal justice data. Design, Setting, and Participants: A cross-sectional sample was created using 2015 data from 4 Maryland databases: all-payer hospital discharges, the prescription drug monitoring program (PDMP), public-sector specialty behavioral treatment, and criminal justice records for property or drug-associated offenses. Maryland adults aged 18 to 80 years with records in any of 4 databases were included, excluding individuals who died in 2015 or had a non-Maryland zip code. Logistic regression models were estimated separately for risk of fatal and nonfatal opioid overdose in 2016. Model performance was assessed using bootstrapping. Data analysis took place from February 2018 to November 2019. Exposures: Controlled substance prescription fills and hospital, specialty behavioral health, or criminal justice encounters. Main Outcomes and Measures: Fatal opioid overdose defined by the state medical examiner and 1 or more nonfatal overdoses treated in Maryland hospitals during 2016. Results: There were 2 294 707 total individuals in the sample, of whom 42.3% were male (n = 970 019) and 53.0% were younger than 50 years (647 083 [28.2%] aged 18-34 years and 568 160 [24.8%] aged 35-49 years). In 2016, 1204 individuals (0.05%) in the sample experienced fatal opioid overdose and 8430 (0.37%) experienced nonfatal opioid overdose. In adjusted analysis, the factors mostly strongly associated with fatal overdose were male sex (odds ratio [OR], 2.40 [95% CI, 2.08-2.76]), diagnosis of opioid use disorder in a hospital (OR, 2.93 [95% CI, 2.17-3.80]), release from prison in 2015 (OR, 4.23 [95% CI, 2.10-7.11]), and receiving opioid addiction treatment with medication (OR, 2.81 [95% CI, 2.20-3.86]). Similar associations were found for nonfatal overdose. The area under the curve for fatal overdose was 0.82 for a model with hospital variables, 0.86 for a model with both PDMP and hospital variables, and 0.89 for a model that further added behavioral health and criminal justice variables. For nonfatal overdose, the area under the curve using all variables was 0.85. Conclusions and Relevance: In this analysis, fatal and nonfatal opioid overdose could be accurately predicted with linked administrative databases. Hospital encounter data had higher predictive utility than PDMP data. Model performance was meaningfully improved by adding PDMP records. Predictive models using linked databases can be used to target large-scale public health programs.

A Systematic Review of Organizational and Workforce Interventions to Improve the Culture and Climate of Youth-Service Settings.

Both organizational culture and climate are associated with service quality and outcomes across youth-service settings. Increasing evidence indicates capacity of organizational interventions to promote a positive and effective culture and climate. Less is known about common intervention components across studies and service settings. The current systematic review reviewed 9223 citations and identified 31 studies, across six youth-service settings, measuring changes over time in organizational culture and climate following implementation of an organizational or workforce support intervention. Results highlight the promise of organizational interventions, a need for more comparison and randomized designs, and future directions for maximizing capacity of organizations to promote health for frontline providers and the children they serve.

The association of criminal justice supervision setting with overdose mortality: a longitudinal cohort study.

BACKGROUND AND AIMS: Despite the high prevalence of substance use among people in the US criminal justice system, little is known about the incidence of overdose mortality by use patterns, drug convictions and supervision setting. We examined the associations between these characteristics and overdose mortality. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Individuals sentenced to prison, jail, probation or jail plus probation for a felony conviction in Michigan, USA from 2003 to 2006. MEASUREMENTS: Using the National Death Index, we assessed overdose mortality to December 2012. We calculated overdose mortality rates by pre-sentence opioid use, drug convictions and supervision setting. Multivariable analyses were conducted using competing risks regression with time-varying covariates. FINDINGS: Among 140 266 individuals followed over a mean of 7.84 years [standard deviation (SD) = 1.52], 14.9% of the 1131 deaths were due to overdose (102.8 per 100 000 person-years). Over the follow-up, more than half of overdose deaths occurred in the community (57.7%), nearly a third (28.8%) on probation and 12.8% on parole. The adjusted risk of overdose death was lower on probation [hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.60, 0.85] than in the community without probation or parole (HR = 1.00) but not significantly different on parole (HR = 1.13, 95% CI = 0.87, 1.47). Pre-sentence daily opioid use (HR = 3.54, 95% CI = 3.24, 3.87) was associated with an increased risk. Drug possession (HR = 1.11, 95% CI = 0.93, 1.31) and delivery convictions (HR = 0.92, 95% CI = 0.77, 1.09) were not significantly associated with overdose mortality. CONCLUSIONS: Based on the absolute or relative risk, parole, probation and community settings are appropriate settings for enhanced overdose prevention interventions. Ensuring that individuals with pre-sentence opioid use have access to harm reduction and drug treatment services may help to prevent overdose among people involved with the criminal justice system.

Therapeutic Jurisprudence and Restorative Justice in Brazil.

The Brazilian prison population in 2016 had increased by more than 700%, compared with the situation in the early 1990s, from 90 thousand to 726.7 thousand. The ordinary response to prison overcrowding came through changes to the justice system, such as Therapeutic Jurisprudence and Restorative Justice. Although these new processes are socially relevant, there are few studies about them anywhere, but especially in Brazil. This study seeks to discuss the perceptions of Brazilian judges upon these new ways of dispensing justice from the perspective of institutional change theory. The data collection involved document analysis, court-hearing observations, and interviews with 14 key-actors in the Brazilian justice system. The results show four dimensions-beliefs, motivations, commitment, and intergroup relations-that characterize the roles played by Brazilian judges working with Therapeutic Jurisprudence and Restorative Justice. This movement can be classified as the modal type of institutional change called layering and "radical" frame blending.

Moving Upstream to Improve Children's Mental Health Through Community and Policy Change.

Using a social determinants of health framework, we argue that the majority of evidence-based interventions focused on child and adolescent mental health are limited by their focus on individual youth (and sometimes families). While necessary, these interventions are insufficient for addressing the midstream- and upstream/macro-level determinants of mental health in society. We illustrate our perspective through four examples from youth mental health and related services, in which midstream and upstream interventions-i.e., at the community and public policy levels-need to be prioritized along with downstream treatments to improve population mental health and reduce social inequalities in mental health outcomes.