Community-based participatory research with police: Development of a tech-enhanced structured suicide risk assessment and communication smartphone application.

OBJECTIVE: Police officers initiate psychiatric holds following determination of suicide risk. Such referrals constitute direct decriminalization of mental illness at the single most efficient criminal justice system diversion point. However, system-level problems with this process highlight a need to further understand and improve this service connection juncture. The goal of the present study was to inform the development of a smartphone application designed to enhance police referrals of individuals experiencing suicide crises into treatment via culturally responsive structured professional judgment. HYPOTHESES: Given the developmental and qualitative nature of this study, there were no formal hypotheses tested. Research questions included the following: Would police officers broadly endorse concerns about the care referral process? Would officers support the use of technology to assist with those concerns? And would officers raise concerns about the demands on time and expertise that would be placed on them to conduct thorough risk assessments? METHOD: Researchers used community-based participatory research (CBPR) methods to obtain police stakeholder-driven data through four focus groups with 47 police officers (76.6% male, 59.6% White, with a mean of 10.7 years of police employment) sampled from patrol and hostage negotiation units. Participants shared information about specific problems arising in the process through which police refer people to medical care, and they gave feedback on the beta version of a culturally responsive mobile app designed to streamline officers' evidence-based and culturally informed determinations of suicide risk. RESULTS: Results, qualitatively coded using grounded theory methodology, yielded key considerations for police use of culturally responsive apps to divert individuals in suicidal crisis into treatment, including the need to maintain a balance between risk assessment and communication, allow for variance in time constraints, allow for flexibility in response and report options, account for inaccurate reports of suicide risk factors, maximize utility of the app's risk report output, incorporate sensitivity around cultural questions, and consider officers' safety in their use of the app in the field. CONCLUSIONS: The results illustrate a theoretically based (CBPR) approach to cross-disciplinary technology development to facilitate evidence-based assessments by law enforcement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A randomized controlled trial of moral reconation therapy to reduce risk for criminal recidivism among justice-involved adults in mental health residential treatment.

OBJECTIVE: Moral reconation therapy (MRT) is a cognitive-behavioral intervention to reduce risk for criminal recidivism. Despite being implemented widely in correctional settings, there are no randomized controlled trials of MRT, and its effectiveness for reducing recidivism among justice-involved adults in noncorrectional settings is unknown. METHOD: In a pragmatic trial, 341 justice-involved patients (95.3% male; 57.8% White/non-Hispanic) admitted to one of three mental health residential treatment programs were randomly assigned to usual care (UC) or UC plus two MRT groups per week for 12 weeks. Follow-ups were conducted at 6- and 12-month postbaseline (71.3% and 74.8% retention, respectively). Primary outcomes were criminal thinking and criminal associates. Secondary outcomes were legal problem severity, days incarcerated in the past 30, rearrested/charged (per official records), substance use, and employment and family/social problems. The study design, analysis, and outcomes were preregistered (ClinicalTrials.gov; ID: NCT02524171). RESULTS: Patients in both conditions improved over time on most outcomes. In intent-to-treat analyses, the rate of change in outcomes over time did not differ by condition, nor did the prevalence of being rearrested and charged within 1 year of baseline (UC = 20.2%, MRT = 24.9%; OR = 1.14; 95% CI [0.67, 1.94], p = .63). MRT engagement was low; 37% of those randomized to MRT received a minimum dose-that is, completed at least Step 3. In per-protocol analyses, this subgroup, relative to UC, improved more on criminal associates, days incarcerated, legal problem severity, and alcohol use severity. CONCLUSIONS: In this study, MRT was not more effective than UC at reducing recidivism risk for patients in mental health residential treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A national train-the-trainer program to enhance police response to veterans with mental health issues: Primary officer and trainer outcomes and material dissemination.

Law enforcement officers (LEOs) may play the most important role in directing people in mental health crises into treatment versus incarceration. While most military veterans will never experience a crisis interaction with LEOs, they represent an important at-risk target group for whom to enhance LEO response. The evidence supporting LEO crisis training models includes important limitations that stem from jurisdiction-limited studies, and emphasize LEOs who volunteer for mental health training. The current study reports the primary outcomes of a national (U.S.) large-scale mandated train-the-trainer program to enhance VA LEO response to military veterans with mental health issues. Multidisciplinary teams comprised of VA LEOs, Veterans Justice Outreach Specialists, and mental health professionals (n = 245) were trained in two nested waves. Both trainers and endpoint LEOs (n = 1,284) improved from pretest to posttest on knowledge and skills in identifying psychological services and related treatment referral resources and cross-discipline collaboration, the latter of which showed some retention at 3-month follow-up. The findings support the potential for LEOs mandated to training to improve in important prerequisites to diverting people with mental health issues into care, and away from the criminal justice system. Such results may require professional trainers of LEOs who have themselves received relevant specific training. Potential cautions of such an approach, including inter-team differences and potential for publication bias in extant literature, are also elucidated by the current methodology. The links to all of the collaboratively-developed curriculum materials from the current study are provided for use by qualified professionals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Gender and Generational Differences in the Internalized Homophobia Questionnaire: An Alignment IRT Analysis.

Internalized homophobia (IH) refers to negative attitudes and stereotypes that a lesbian, gay, or bisexual (LGB) person may hold regarding their own sexual identity. Recent sociocultural changes in attitudes and policies affecting LGB people generally reflect broader acceptance of sexual minorities, and may influence the manner in which LGB people experience IH. These experiences should be reflected in the measurement properties of instruments designed to assess IH. This study utilized data from three different samples (N = 3,522) of LGB individuals residing in the United States to examine the invariance of a common self-report IH measure by gender identity (Female, Male) and age cohort (Boomers, Generation X, and Millennials). Multigroup item response theory-differential item functioning analysis using the alignment method revealed that 6 of the 9 Internalized Homophobia Scale items exhibited differential functioning across gender and generation. Latent scores based on the invariant items suggested that Male and Female Boomers exhibited the lowest level of latent IH, relative to the other cohorts.