Implementing evidence-based supported employment within specialty mental health probation: A hybrid type I implementation-effectiveness trial protocol.

BACKGROUND: People with serious mental illnesses who are involved in the criminal justice system face significant challenges in obtaining meaningful employment. Given the importance of employment in reducing recidivism, the field needs effective interventions to increase employment rates, address mental health needs, and reduce recidivism for justice-involved people with serious mental illnesses. Individual Placement and Support - Supported Employment (IPS-SE) improves employment outcomes among individuals with serious mental illnesses and has shown promising results when implemented with individuals with histories of justice involvement; however, IPS-SE has only been implemented in mental health service settings. Given lower levels of treatment engagement and completion among justice-involved populations, implementation of IPS-SE in specialty mental health probation (SMHP) is an opportunity to increase reach and engagement among justice-involved people with serious mental illnesses. METHODS: This article describes a hybrid type 1 implementation-effectiveness study that aims to: (1) assess the implementation enablers and barriers, as well as the feasibility, appropriateness, and acceptability of IPS-SE embedded within SMHP; (2) identify the multi-level factors (i.e., implementation determinants) that influence IPS-SE implementation within the context of a probation setting; and (3) assess the impact of IPS-SE on employment - our primary endpoint - and the impact of IPS-SE on a number of secondary outcomes and potential treatment mechanisms. The efficacy arm of the study will be a randomized controlled trial of 130 adults on community supervision who will either receive treatment as usual or IPS-SE. The implementation arm of the study will examine implementation determinants and implementation outcomes using qualitative methods.

Perceptions of vaccine safety and hesitancy among incarcerated adults and correctional staff in the rural midwest.

Objectives: This project assessed vaccine hesitancy among staff and incarcerated adults in one rural medium-security prison in the Midwestern United States and identified differences in hesitancy across sociodemographic and work-related variables. Methods: 610 prison staff and people incarcerated completed a cross-sectional survey in May 2021. The vaccine hesitancy scale (VHS) identified perceived risk and confidence in vaccination. A single item assessed whether people typically follow public health protocols in the prison. A combination of analyses was utilized, including ANOVA, Chi-Square, and Pearson's correlation. Results: Vaccine hesitancy was moderate to high for both populations. Incarcerated people had more confidence in vaccination than staff; differences did not reach statistical significance. Incarcerated people had statistically significantly higher perceptions of risk compared to staff. Both populations reported doing their best to follow public health protocols. For both populations, vaccine hesitancy varied by education and veteran status. Among staff, hesitancy varied by gender and political beliefs. For people incarcerated, it varied by pre-incarceration income and visit frequency. Conclusions: Results support the need for public health policy and procedural interventions to reduce hesitancy towards vaccination in correctional settings.

Feasibility of recruiting in prisons during a randomized controlled trial with people with serious mental illness.

BACKGROUND: Successful participant recruitment is vital to the feasibly of intervention research. In the behavioral and social sciences, intervention researchers face a myriad of recruitment barriers, many of which stem from working in real-world settings and among hard-to-access populations. Optimizing recruitment efforts requires being intentional about study planning and resource allocation, carefully documenting the outcomes of recruitment efforts, and developing and implementing procedures and strategies to overcome anticipated recruitment barriers. METHODS: The current article presents recruitment flowcharts to illustrate (a) the multistep recruitment process and (b) the points of potential participant attrition during recruitment from a two-phase group-based intervention study conducted among individuals with serious mental illness incarcerated in a state prison system in the U.S. In addition, qualitative methods are used to examine strategies employed during the study to support recruitment efforts. RESULTS: Despite challenges, this study was able to achieve recruitment goals. Analyses found the majority of potential participant attrition occurred prior to informed consent, highlighting the need for studies to track recruitment efforts in more detail than is currently recommended by commonly used guidelines. Strategies to optimize recruitment efforts included maximizing recruiter availability, developing a responsive communication approach, demonstrating respect for facility procedures and operations, and ensuring peak preparedness. CONCLUSION: Careful documentation of recruitment efforts and the early deployment of recruitment strategies is vital to the feasibility of intervention studies conducted in real-world settings with hard-to-access populations. The publication of recruitment procedures and outcomes can help future researchers anticipate recruitment challenges and inform recruitment goals, timelines, and strategies.

Understanding Intimate Partner Violence Service Delivery for Latinx Survivors in Rural Areas.

Using a statewide survey, this exploratory, cross-sectional study examined 78 domestic violence (DV) service organizations' service delivery practices and perceived challenges to serving Latinx survivors in the context of rurality. Findings showed that DV organizations in rural areas perceived more challenges to delivering culturally appropriate services for Latinx survivors compared to those in other geographic settings even after accounting for client characteristics, service provision characteristics, and community resources. The study finding offers critical insights to ensure and enhance the provision of linguistically and culturally accessible services for rural Latinx survivors of intimate partner violence.

Mental illness-related stigma among probation officers.

BACKGROUND: Probation officers tend to hold stigmatising attitudes towards individuals on their caseload with mental illnesses. This can result in poor outcomes for justice-involved people with mental illnesses. Though anti-stigma interventions in the general public and among other criminal-legal professionals hold promise, these interventions have not been tested among probation officers. AIMS: To measure levels of stigma towards mental illnesses among probation officers before and after a brief online training related to mental illness. METHODS: Two hundred and seventy-five probation and parole officers in one Midwest state completed a three-module online training programme designed to increase knowledge and skills for working with clients with mental illnesses. Officers completed a pre- and post-training assessment of level of stigmatising attitudes towards individuals with mental illnesses. RESULTS: Officer levels of stigma statistically significantly decreased from pre-test (8.22) to post-test (7.37; p < 0.001, t = 6.13). Nevertheless, pre-training stigma scores were the strongest predictor of stigma levels at post-test (p < 0.001, b = 0.90). CONCLUSIONS: While basic training can significantly decrease mental disorder stigmatising scores for probation officers, the practical effect of this brief online experience was very small. Nevertheless, the fact that such brief and generalised input can have impact at all is encouraging. Implementation could be a useful preliminary to improving the quality of probation supervision of clients with mental illnesses.

A Randomized Trial of Specialty Mental Health Probation: Measuring Implementation and Effectiveness Outcomes.

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.

Traumatic experiences among individuals with severe mental illnesses on probation.

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.

Physical Health Problems Among People With Severe Mental Illnesses: Race, Gender, and Implications for Practice.

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.

Accountability in Intervention Research: Developing a Fidelity Checklist of a Mental Health Intervention in Prisons.

Adherence to intervention content and delivery protocols is vital in establishing the efficacy of treatment programs for mental illnesses. Using a fidelity tool during interventions can substantially increase the likelihood of clients receiving the most scientifically rigorous treatment. This article outlines the steps taken to develop a fidelity checklist to measure treatment adherence of a two-part intervention delivered in a prison setting. Researchers followed the five-step guide by Feely et al. (Child and Adolescent Social Work Journal, 35(2), 139-152: 2018) and describe the process of developing a fidelity tool to measure treatment adherence to a newly adapted CBT-based intervention designed to maximize uptake for participants with serious mental illnesses. Key decision points are discussed, along with final decisions and contextual considerations. A 26-item checklist was developed to measure treatment adherence related to process, content, and adaptations of the intervention. The checklist follows the structure of the CBT intervention, as well as provides flexibility for the delivery adaptations. Pilot testing of the checklist revealed all sessions were implemented with at least 85% fidelity, and 90% of sessions were implemented with at least 90% fidelity. Raters agreed on the fidelity of a session in 99.6% of sessions. Contextual considerations included the highly secure study setting, reconciling the constant monitoring of a group and creating a treatment environment, the flexibility mandated by the intervention, the relative newness of the intervention, and the limitations based on study aims and resources. These results illustrate how study specific considerations and challenges can be successfully navigated in the development and deployment of a fidelity tool in a real-world setting. The fidelity checklist achieved our goal of measuring treatment adherence for this intervention. In the development of a fidelity tool, we recommend leaving space for raters to note specific considerations that disrupt facilitators' ability to deploy the intervention precisely. Measuring fidelity is imperative for mental health interventions to ensure that the treatment is responsible for the changes observed in clients.

Social support among people with mental illnesses on probation.

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) 2021 APA, all rights reserved).

Investigating the Complex Relationship Between Intimate Partner Violence Victimization and Perpetration Among System-Involved Women in Heterosexual Relationships: An Exploratory Analysis.

Research indicates women who perpetrate intimate partner violence (IPV) experience both more frequent and more severe IPV victimization. However, the IPV field needs additional research to understand the complex relationship between various forms of IPV victimization (e.g., psychological, physical, sexual) and IPV perpetration by women. In particular, the field needs a better understanding of the unique interplay of various forms of IPV victimization and perpetration among female system-involved survivors (i.e., female survivors involved with child protective services and/or the court system and mandated to services). Such understanding would aid extant efforts to ensure that mandated services address the experiences and meet the needs of these system-involved women. To address this knowledge gap, we conducted an exploratory, secondary data analysis using cross-sectional baseline data collected as part of a larger evaluation study of a psychoeducational therapeutic IPV and parenting program for system-involved IPV survivors mandated to services (N = 73). Results from multiple regression analyses revealed that both psychological and physical IPV victimization were uniquely associated with the perpetration of psychological and physical abuse by system-involved female IPV survivors. Furthermore, our examination of the interaction between physical and psychological victimization and its impact on perpetration revealed that higher levels of both physical and psychological IPV victimization were associated with significantly higher levels of psychological perpetration (p < .01) and increased likelihood of physical perpetration (p < .05). Results are discussed in the context of service provision within systems, agencies, and programs targeting system-involved women mandated to services for IPV.

Prison-Based Interventions for Early Adults with Mental Health Needs: A Systematic Review.

Rates of mental health needs of incarcerated young adults (15-35 year olds) are concerning, however, mental health interventions targeting this population are under studied. This article systematically reviews published, peer-reviewed research in nine databases pertaining to mental health interventions for incarcerated young adults. Only original studies conducted in the United States and determined to be valid though NIH assessment tools were included in this analysis. The review includes 19 original studies testing 14 intervention programs exploring mental health outcomes such as depression, PTSD, self-harm, and bipolar symptoms. Overall, findings were mixed about the impact of reviewed programs. The variety of interventions, outcomes, study settings, and implementation procedures complicates the ability to determine the impact of mental health programming in carceral settings. This review also reveals the lack of depth and replication of research in this area. Findings suggest additional efforts are needed to establish efficacy and best practices when treating mental health needs among this population.

Risk Factors for Criminal Recidivism Among Persons With Serious Psychiatric Diagnoses: Disentangling What Matters for Whom.

Reducing criminal legal system involvement requires an understanding of the factors that promote repeat offending (i. e., recidivism), and the dissemination of relevant interventions to those most likely to benefit. A growing body of research has established common recidivism risk factors for persons with serious psychiatric disorder diagnoses. However, research to date has not examined the degree to which these risks apply to those with serious psychiatric disorders with and without co-occurring substance use disorders. To clarify what risk and need factors are greatest and for whom, this cross-sectional study drew from an original dataset containing data on 14 social and economic, psychological, and criminal risk areas for a cohort of people on probation (n = 4,809). Linear regression models indicated that, compared to those without a serious psychiatric disorder, people on probation with a serious psychiatric disorder are at greater risk in a minority of areas and those areas are mostly social and economic in nature. Meanwhile, those withco-occurring disorders are at relatively high risk across almost all areas. The results from this study suggest that justice involved persons with serious psychiatric disorders will benefit from interventions that increase social support and economic well-being and that interventions that broadly reduce risk among people with co-occurring serious psychiatric and substance use disorders will likely yield meaningful reductions in system involvement. Ultimately, understanding and intervening upon risk for recidivism among persons with serious psychiatric disorders requires differentiating between those with and without co-occurring substance use disorders.

Intimate Partner Violence Among Same-Sex Couples in College: A Propensity Score Analysis.

Intimate partner violence (IPV) is a pervasive social issue with numerous detrimental effects on individuals, families, and society. Existing research and a social-ecological minority stress framework suggest, as compared with mixed-sex couples, those in same-sex relationships may be at heightened risk for perpetrating and experiencing IPV. Using a U.S. sample of college students ( N = 4,081), this secondary data analysis contrasted the prevalence of five forms of IPV (i.e., physical, sexual, psychological, injury, any type) between those in mixed-sex ( n = 3,960) and those in same-sex ( n = 121) intimate partnerships. Comparative analyses were supplemented with propensity score weighting to help balance members of mixed-sex and same-sex relationships across eight potentially confounding variables (e.g., biological sex, age). Prior to the application of propensity score weighting, results suggested those in same-sex relationships are significantly more likely to perpetrate and/or experience IPV resulting in physical injury. Results from post-weighting analyses retained the significance and magnitude of model estimates. Taken together, results suggest, as compared with mixed-sex couples, U.S. college students in same-sex couples have greater odds of experiencing IPV perpetration and victimization resulting in physical injury, even after accounting for the influence of several potentially confounding variables. Findings support the utility and future application of propensity score analytic techniques in this type of research as well as the importance of recognizing the unique IPV risk and service needs of people in same-sex relationships.