Correlates of Staff Acceptability of a Novel Telemedicine-Delivered Medications for Opioid Use Disorder Program in a Rural Detention Center.

Opioid overdose death is significantly increased immediately following incarceration. Evidence-based medications are underutilized in rural jails and detention centers. We have reported our efforts to address this gap through telemedicine-based medications for opioid use disorder treatment (tele-MOUD) for incarcerated patients. Staff acceptance and perceptions are critically important factors in the assurance of program validation. We assessed tele-MOUD acceptability and perceptions of effectiveness and stigma in one detention center. Overall, we found that jail staff's general acceptability of the program was rather low, as was perceived effectiveness of MOUD, while stigmatizing beliefs were present. Furthermore, tele-MOUD acceptability was positively correlated with perceptions of MOUD effectiveness and negatively correlated with stigmatizing notions of MOUD (p's < 0.001). Findings suggest the need for educational interventions. Future research investigating the potential moderating effects of training on staff acceptability of jail-based tele-MOUD will support the implementation and sustainability of these life-saving programs.

The impact of drug court participation on mortality: 15-year outcomes from a randomized controlled trial.

AIM: To test the effects of drug court participation on long-term mortality risk. METHODS: During 1997-98, 235 individuals charged with a non-violent offense were randomly assigned to Baltimore City Drug Treatment Court (BCDTC) or traditional adjudication. Heroin was the predominant substance of choice among the sample. Participant mortality was observed for 15 years following randomization. RESULTS: Over 20% of participants died during the study, at an average age of 46.6 years, and 64.4% of deaths were substance-use related. Survival analyses estimated that neither mortality from any cause nor from substance use-related causes significantly differed between BCDTC and traditional adjudication. CONCLUSIONS: Frequent and premature death among the sample indicates that this is a high-risk population in need of effective substance use treatment. Roughly half of drug treatment courts are now estimated to offer medication assisted treatment (MAT), which is currently the most effective treatment for opioid use disorders. In this study of BCDTC implemented over 15 years ago, only 7% of participants received MAT, which may explain the lack of program impact on mortality. Historical barriers to providing MAT in drug court settings include access, concerns about diversion, negative attitudes, blanket prohibitions, and stigma. Drug treatment courts should implement best practice standards for substance use treatment and overdose prevention, including increased access to MAT and naloxone, and training to reduce stigmatizing language and practice.

Scaling-Up Evidence-Based Programs Using a Public Funding Stream: a Randomized Trial of Functional Family Therapy for Court-Involved Youth.

The Affordable Care Act expanded access to Medicaid programs and required them to provide essential health benefits, which can include prevention services. This study assesses the costs and benefits to using Medicaid funding to implement a well-known evidence-based program, Functional Family Therapy (FFT), with a sample of juvenile justice-involved youth. The study also provides a rigorous test of FFT accommodated for a contemporary urban population that is gang at risk or gang-involved. One hundred twenty-nine predominantly minority and low income families were randomly assigned to receive an enhanced version of FFT or an alternative family therapy. Data from pre- and post-intervention interviews with youth and parents, court records of contacts with the justice system and residential placements, official records of community services, and the costs of placements and services are summarized. The intervention was implemented with fidelity to the FFT model using Medicaid funding. Treatment and control subjects received a wide range of community and residential services in addition to FFT. A higher percentage of treatment subjects than controls received services following random assignment, but the cost per youth served was lower for treatment than control youth, primarily because control youth were more often placed in residential facilities. Recidivism during the 18-month follow-up period was lower for FFT than for control youth. The combination of cost savings realized from avoiding more costly services and the expected future savings due to recidivism reduction suggest the expanded use of evidence-based practices using public funding streams such as Medicaid is warranted.

The impact of residential change and housing stability on recidivism: pilot results from the Maryland Opportunities through Vouchers Experiment (MOVE).

OBJECTIVES: This article provides a description and preliminary assessment of the Maryland Opportunities through Vouchers Experiment (MOVE), a randomized housing mobility program for former prisoners designed to test whether residential relocation far away from former neighborhoods, incentivized through the provision of a housing subsidy, can yield reductions in recidivism. METHODS: The MOVE program was implemented as a randomized controlled trial. Participants were recruited from four different Maryland prisons and randomly assigned to experimental groups. In the first iteration of the experiment, treatment group participants received 6 months of free housing away from their home jurisdiction and control group participants received free housing back in their home jurisdiction. In the second iteration of the experiment, the treatment group remained the same and the control condition was redesigned to represent the status quo and did not receive free housing. Analyses were conducted of one-year rearrest rates. RESULTS: With respect to reductions in recidivism, pilot results suggest that there is some benefit to moving and a benefit to receiving free housing. Rearrest was lower among the treatment group of movers than the non-movers, and was also lower for non-movers who received free housing versus non-movers who did not receive housing. CONCLUSIONS: To the extent that pilot results can be validated and replicated in a full-scale implementation of the MOVE program, policies that provide greater access to housing assistance for formerly incarcerated individuals may yield substantial public safety benefits, particularly housing opportunities located far away from former neighborhoods.

The Baltimore City Drug Treatment Court: 3-year self-report outcome study.

This study reports results from interviews with 157 research participants who were interviewed 3 years after randomization into treatment and control conditions in the evaluation of the Baltimore City Drug Treatment Court. The interviews asked about crime, substance use, welfare, employment, education, mental and physical health, and family and social relationships. Program participants reported less crime and substance use than did controls. Few differences between groups were observed on other outcomes, although treatment cases were less likely than controls to be on the welfare rolls at the time of the interview. Effects differed substantially according to the originating court.