Interpersonal process features of collaboration between probation and behavioral health practitioners.

This study sought to identify and conceptualize the central interpersonal process features that comprise good collaboration between behavioral health practitioners (BHPs) and probation officers (POs). Eighteen POs and 21 BHPs from geographically adjacent jurisdictions in a Midwestern state each participated in one of six focus groups. Researchers systematically coded focus group transcripts for interpersonal collaborative themes using both inductive and deductive strategies. Seven core themes-shared values and beliefs, communication and information sharing, knowledge of the other, trust, respect, team-based decision making, and equitable contribution-were identified and coded for importance, as indexed by frequency, latent tone, and group consensus. An initial working operational definition of these constructs, based on practitioners' dialogue, is also provided. This study is one of the first to provide BHPs and POs who work with justice-involved people with prescriptive guidance about interpersonal actions and approaches that will best serve their professional collaborative efforts. Future research should examine whether these constructs hold across other samples and contexts and work to fully operationalize and measure these constructs and their importance for affecting various outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Communication and collaboration in a drug court team.

A multidisciplinary team is a hallmark feature of drug courts and other specialized treatment dockets. Comprised primarily of practitioners from the criminal legal system and mental health and addictions services treatment systems, team members exchange information and engage in shared decision-making. Though practitioners in these contexts have some guidance regarding organizational and structural elements needed to facilitate efficient and effective communication and collaboration, less is known about the role individual team members' actions and behaviors play in this process. Using data from a survey, process evaluation, and qualitative interviews administered to 19 members of a single drug court team in a Midwestern urban setting, this study describes several communication and collaboration practices of drug court team members and explores how they may contribute to the general effectiveness of the drug court. This study underscores the potential utility of operationalizing and measuring day-to-day, individual-level communication and collaboration practices in future studies of drug court process, in order to index drug court team dynamics that may contribute to its effectiveness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Data-Driven Response to the Addiction Crisis in Hamilton County, Ohio.

CONTEXT: For more than a decade, the state of Ohio has been an epicenter of the opioid crisis. Multiple interventions have been deployed to address this crisis and reduce opioid overdoses and overdose deaths in the state. The Hamilton County Addiction Response Coalition (HC ARC) and its strategic, countywide prearrest diversion (LEAD) and deflection (QRT) programs have been at the forefront of this effort in Cincinnati, Ohio. Operating since April 2018, these programs have continued to grow and improve and have been successful in connecting hundreds of citizens to needed treatment and other social services. PROGRAM: HC ARC combats overdoses and overdose deaths by utilizing cross-sector planning and collaboration to operate 2 countywide programs: Quick Response Team (QRT) and Law Enforcement Assisted Diversion (LEAD). IMPLEMENTATION: The QRT and LEAD programs leverage partnerships with law enforcement, public health, addiction and mental health services, reentry services, and trained peer supporters. The QRT emphasizes triage, assessment, and connection to appropriate services for people with recent nonfatal drug overdoses and provides outreach and education in hot spot communities. LEAD provides diversion from the criminal justice system into long-term case management for nonviolent individuals with low-level offenses who also struggle with substance use disorder, mental health, homelessness, and/or poverty. EVALUATION: QRT and LEAD team members routinely track and record client contacts and outcomes using a centralized electronic case management platform. Data are extracted and analyzed by the evaluation team to examine indices of program success and provide ongoing feedback to the QRT and LEAD teams. DISCUSSION: HC ARC has implemented, tested, expanded, and now standardized its prearrest diversion programming. It has built a sustainable model to improve health and health equity for marginalized individuals whose needs intersect across health care, public health, community-based social services, and the criminal-legal system. Collectively, this work offers a guide for implementation and best practices for the following: detailed planning, policy, and procedure development; identification of key leaders and community partners; and methods to evaluate program operations to make data-driven decisions and real-time program adjustments.

Opioid-specific medication-assisted therapy and its impact on criminal justice and overdose outcomes.

Background: The overlap between justice system involvement and drug use is well-documented. Justice-involved people who misuse opioids are at high risk for relapse and criminal recidivism. Criminal justice policymakers consider opioid-specific medication-assisted therapies (MATs) one approach for improving outcomes for this population. More research is needed that explores the impacts of opioid-specific MATs for justice-involved people. Objectives: This study sought to assess the effects of opioid-specific MAT for reducing the frequency and likelihood of criminal justice and overdose outcomes for current or formerly justice-involved individuals. Search Methods: Records were searched between May 7, 2021 and June 23, 2021. We searched a total of sixteen proprietary and open access databases that included access to gray literature and conference proceedings. The bibliographies of included studies and relevant reviews were also searched. Selection Criteria: Studies were eligible for inclusion in the review if they: (a) assessed the effects of opioid-specific MATs on individual-level criminal justice or overdose outcomes; included (b) a current or formerly justice-involved sample; and (c) a randomized or strong quasi-experimental design; and c) were published in English between January 1, 1960 and October 31, 2020. Data Collection and Analysis: We used the standard methodological procedures as expected by The Campbell Collaboration. Main Results: Twenty studies were included, representing 30,119 participants. The overall risk of bias for the experimental studies ranged from "some" to "high" and for quasi-experimental studies ranged from "moderate" to "serious." As such, findings must be interpreted against the backdrop of less-than-ideal methodological contexts. Of the 20 included studies, 16 included outcomes that were meta-analyzed using mean log odds ratios (which were reported as mean odds ratios). Mean effects were nonsignificant for reincarceration (odds ratio [OR] = 0.93 [0.68, 1.26], SE = .16), rearrest (OR = 1.47 [0.70, 3.07], SE = 0.38), and fatal overdose (OR = 0.82 [0.56, 1.21], SE = 0.20). For nonfatal overdose, the average effect was significant (OR = 0.41 [0.18, 0.91], SE = 0.41, p < 0.05), suggesting that those receiving MAT had nearly 60% reduced odds of a nonfatal overdose. Implications for Policy Practice and Research: The current review supports some utility for adopting MAT for the treatment of justice-involved people with opioid addiction, however, more studies that employ rigorous methodologies are needed. Researchers should work with agencies to improve adherence to medication regimens, study design, and collect more detailed information on participants, their criminal and substance use histories, onset, and severity. This would help clarify whether treatment and control groups are indeed comparable and provide better insight into the potential reasons for participant dropout, treatment failure, and the occurrence of recidivism or overdose. Outcomes should be assessed in multiple ways, if possible (e.g., self-report and official record), as reliance on official data alone may undercount participants' degree of criminal involvement.

PROTOCOL: Opioid-specific medication-assisted therapy and its impact on criminal justice and overdose outcomes.

Background: The overlap between criminal justice system involvement and drug use is well-documented, and criminal justice agencies have been particularly overwhelmed by the recent opioid epidemic. Treating opioid (and other substance) addiction as a means to reduce risk for future criminality and improve public safety is inherently a responsibility for the criminal justice system. In turn, the criminal justice system has a responsibility to manage and treat addiction among the individuals under its purview.  Policy recommendations place emphasis on the use of medication-assisted treatments (MAT) as a front-line defense among correctional populations, because its efficacy and effectiveness has been well-established in other contexts.  Despite this, criminal justice agencies have been reluctant or slow to do so. Objectives: The current review will provide criminal justice and substance use treatment decision-makers with information regarding the efficacy and effectiveness of opioid-specific MAT on offending and overdose outcomes. Specifically, the authors will address the following research questions: Do opioid-specific MATs reduce the frequency or likelihood of criminal justice outcomes, as defined by official or self-reported indices of criminal reconviction or rearrest, revocation of community supervision, mandated treatment failure, and specialized court docket failure? Do opioid-specific MATs reduce the frequency of opioid overdose among individuals with current or prior self-reported or official record of criminal justice system involvement? Inclusion Criteria: Studies were required to use strong quasi-experimental or randomized experimental designs. All studies used individual level unit of analysis and examined adults and adolescents who are male, female, or nonbinary and racially/ethnically diverse, with current opioid use and who have current or prior criminal justice involvement. Studies had to prospectively test the effects of heroin and methadone maintenance, buprenorphine, or naltrexone on criminal conviction, arrest, revocation of community supervision, technical probation or parole violation, mandated treatment failure, and specialized court docket failure. Overdose outcomes were also examined for samples in criminal justice settings such as jails, prisons, probation, and parole. Search Strategy and Data Collection: This review builds upon a prior review conducted by Egli et al. (2009) and examined studies meeting the inclusion criteria above published between 1960 and October 31, 2020. The following platforms and databases (in parentheticals) were used: EBSCOhost (Criminal Justice Abstracts, SocINDEX with Full Text, Legal Collection, Wilson Omnifile, PsycINFO, Social Work Abstracts, and Women's Studies International [includes grey literature]); ProQuest (Criminal Justice Database, PAIS [includes grey literature], Dissertations and Theses Global [includes grey literature]); Gale (Expanded Academic ASAP, Opposing Viewpoints Resource Center); FirstSearch (GPO Monthly Catalog, PapersFirst [includes grey literature]); ISI Web of Knowledge (Web of Science Core Collection); Office of Justice Programs (National Criminal Justice Reference Service); Summon; and Nexis Uni. The following open access platforms and databases will also be consulted: Elsevier (Scopus [includes grey literature]); Science.gov; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform (ICTRP) portal; and Google Scholar. Search terms were harvested according to their demonstrated success in drawing out relevant and complete results for studies regarding the effectiveness of opioid-specific medication-assisted therapies (MATs). From this process 5 core search strings were created, each one with the same general base terms, but unique outcome measure(s). Analysis: For binary offending outcomes (e.g., arrest, conviction, incarceration, specialty court failure, mandated treatment failure, or community supervision failure) and overdose outcomes, odds ratios were computed, and for continuous or quasi-continuous outcomes (e.g., total number of arrests), a standardized mean difference type effect size was computed and then transformed into an odds ratio. We used the χ 2 test that goes with the forest plot and computed the I 2 statistic to assess heterogeneity. Risk of bias was assessed with (1) the revised Cochrane risk-of-bias tool for randomized trials; and (2) the risk of bias in non-randomized studies of interventions assessment tool.

Comparing Costs of Traditional and Specialty Probation for People With Serious Mental Illness.

OBJECTIVE: Specialty mental health probation reduces the likelihood of rearrest for people with mental illness, who are overrepresented in the justice system. This study tested whether specialty probation was associated with lower costs than traditional probation during the two years after placement in probation. METHODS: A longitudinal, matched study compared costs of behavioral health care and criminal justice contacts among 359 probationers with mental illness at prototypic specialty or traditional agencies. Compared with traditional officers, specialty officers supervised smaller caseloads, established better relationships with supervisees, and participated more in treatment. Participants and officers were interviewed, and administrative databases were integrated to capture service use and criminal justice contacts. Unit costs were attached to these data to estimate costs incurred by each participant over two years. Cost differences were estimated by using machine-learning algorithms combined with targeted maximum-likelihood estimation (TMLE), a double-robust estimator that accounts for associations between confounders and both treatment assignment and outcomes. RESULTS: Specialty probation cost $11,826 (p<.001) less per participant than traditional probation, with overall savings of about 51%. Specialty and traditional probation did not differ in criminal justice costs because the additional costs for supervision of specialty caseloads were offset by reduced recidivism. However, for behavioral health care, specialty probation cost an estimated $14,049 (p<.001) less per client than traditional probation. Greater outpatient costs were more than offset by reduced emergency, inpatient, and residential costs. CONCLUSIONS: Well-implemented specialty probation yielded substantial savings-and should be considered in justice reform efforts for people with mental illness.

Social networks and treatment adherence among Latino offenders with mental illness.

Mental health treatment adherence is often required for offenders with mental illness supervised on probation and parole. However, research on offenders with mental illness has largely overlooked cultural and ethnic responsivity factors that may affect adherence to treatment. Latinos are a quickly growing subgroup of offenders whose social networks differ in meaningful ways from European Americans' (e.g., size, composition, centrality of family). Social networks are known to relate to both clinical and criminal justice outcomes for offenders with mental illness, and there are features of nonoffender Latinos' social networks that suggest that findings distilled from work with non-Latino offenders may not apply to them. The present study examined the social networks of 86 Latino probationers with serious mental illness to (a) describe the size and composition of these networks and (b) to determine which factors of social networks are related to treatment adherence. The authors found that Latino offenders' social networks are small (∼6 individuals), consisting primarily of family and professionals such as treatment providers and probation officers. Supportive relationships with nonprofessionals and treatment providers was related to lower likelihood of missing treatment appointments, whereas social control and pressure from family and friends to attend treatment was not related to treatment adherence. Findings are discussed within the context of improved practices for community corrections and mental health agencies in working with Latino offenders with mental illness. (PsycINFO Database Record

Applicability of the Risk-Need-Responsivity Model to Persons With Mental Illness Involved in the Criminal Justice System.

OBJECTIVE: National efforts to improve responses to persons with mental illness involved with the criminal justice system have traditionally focused on providing mental health services under court supervision. However, a new policy emphasis has emerged that focuses on providing correctional treatment services consistent with the risk-need-responsivity (RNR) model to reduce recidivism. The objective of this review was to evaluate empirical support for following the RNR model (developed with general offenders) with this group and to pose major questions that the field needs to address. METHODS: A comprehensive search using PubMed and PsycINFO yielded 18 studies that addressed the applicability of the RNR model to the target population. The results of these studies were synthesized. RESULTS: There is strong support for using general risk assessment tools to assess this group's risk of recidivism. Preliminary evidence indicates that cognitive-behavioral programs targeting general risk factors are more effective than psychiatric treatment alone. However, there is as yet no direct support for the applicability of the three core RNR principles to treat this population. CONCLUSIONS: Although the new policy emphasis shows substantial promise, the field must avoid rushing to the next "evidence base" too rapidly and with too little data. There must be explicit recognition that RNR principles are being applied to a new population with unique characteristics (mental illness combined with justice system involvement), such that generalizability from general offender samples is uncertain. Moreover, public safety goals for the target population should not eclipse those related to public health. This group's unique features may affect both the process and outcomes of treatment.

High-fidelity specialty mental health probation improves officer practices, treatment access, and rule compliance.

Many probation agencies in the United States assign offenders with mental illness to relatively small specialty caseloads supervised by officers with relevant training, rather than to large general caseloads. Specialty caseloads are designed to improve the process and outcomes of probation, largely by linking these probationers with psychiatric treatment and avoiding unnecessary violations. In this multimethod, longitudinal matched trial, we tested whether a prototypical specialty agency (n = 183) differed from a traditional agency (n = 176) in officers' practices, probationers' treatment access, and probationers' rule violations. The specialty agency yielded significantly (a) better officer practices (e.g., problem solving rather than sanction threats; higher quality relationships with probationers; more boundary spanning), (b) greater rates of treatment involvement, and (c) lower rates of violation reports than the traditional agency. Additionally, officers' use of sanctions and threats increased probationers' risk of incurring a probation violation, whereas high-quality officer-probationer relationships protected against this outcome. When implemented with fidelity, specialty mental health caseloads improved the supervision process for this high-need group.

Care, control, or both? Characterizing major dimensions of the mandated treatment relationship.

Current conceptualizations of the therapeutic alliance may not capture key features of therapeutic relationships in mandated treatment, which may extend beyond care (i.e., bond and affiliation) to include control (i.e., behavioral monitoring and influence). This study is designed to determine whether mandated treatment relationships involve greater control than traditional treatment relationships, and if so, whether this control covaries with reduced affiliation. In this study, 125 mental health court participants described the nature of their mandated treatment relationships using the INTREX (Benjamin, L., 2000, SASB/INTREX: Instructions for administering questionnaires, interpreting reports, and giving raters feedback (Unpublished manual). Salt Lake City, UT: University of Utah, Department of Psychology), a measure based on the interpersonal circumplex theory and assesses eight interpersonal clusters organized by orthogonal axes of affiliation and control. INTREX cluster scores were statistically compared to existing data from three separate voluntary treatment samples, and structural summary analyses were applied to distill the predominant theme of mandated treatment relationships. Compared with voluntary treatment relationships, mandated treatment relationships demonstrate greater therapist control and corresponding client submission. Nonetheless, the predominant theme of these relationships is affiliative and autonomy-granting. Although mandated treatment relationships involve significantly greater therapist control than traditional relationships, they remain largely affiliative and consistent with the principles of healthy adult attachment.

The utility of patients' self-perceptions of violence risk: consider asking the person who may know best.

OBJECTIVE The authors compared the predictive accuracy of two risk assessment methods that are feasible to use in routine clinical settings: brief risk assessment tools and patients' self-perceptions of risk. METHODS In 2002-2003, clinical interviewers met with 86 high-risk inpatients with co-occurring mental and substance use disorders (excluding schizophrenia) to carefully elicit the patients' global rating of their risk of behaving violently and to complete two brief risk assessment tools-the Clinically Feasible Iterative Classification Tree (ICT-CF) and the Modified Screening Tool (MST). Two months after discharge, patients were reinterviewed in the community to assess their involvement in violence. RESULTS Patients' self-perceptions of risk performed quite well in predicting serious violence (area under the curve [AUC]=.74, sensitivity=50%), particularly compared with the ICT-CF (AUC=.59, sensitivity=40%) and the MST (AUC=.66, sensitivity=30%). Self-perceived risk also added significant incremental utility to these tools in predicting violence. CONCLUSIONS Patients' self-perceptions hold promise as a method for improving risk assessment in routine clinical settings. Assuming it replicates and generalizes beyond the research context, this finding encourages a shift away from unaided clinical judgment toward a feasible method of risk assessment built on patient collaboration.

Firm, fair, and caring officer-offender relationships protect against supervision failure.

A growing body of research suggests that high quality dual role relationships between community corrections officers and offenders reduce risk of recidivism. This study assesses whether this finding generalizes from offenders with mental illness to their relatively healthy counterparts. More importantly, this study tests the possibility that this finding is spurious, reflecting the influence of pre-existing offender characteristics more than a promising principle of practice. In this study of 109 parolees without mental illness, the authors found that (a) firm, fair, and caring relationships protect against rearrest, and (b) do so even after accounting for offenders' pre-existing personality traits and risk for recidivism. These findings are consistent with the theoretical notion that good dual role relationships are an essential element of core correctional practice, even (or particularly) for difficult or high risk offenders.

Utility of the Revised Level of Service Inventory (LSI-R) in predicting recidivism after long-term incarceration.

Assessing an inmate's risk for recidivism may become more challenging as the length of incarceration increases. Although the population of Long-Term Inmates (LTIs) is burgeoning, no risk assessment tools have been specifically validated for this group. Based on a sample of 1,144 inmates released in a state without parole, we examine the utility of the Level of Service Inventory-Revised (LSI-R) in assessing risk of general and violent felony recidivism for LTIs (n = 555). Results indicate that (a) the LSI-R moderately predicts general, but not necessarily violent, recidivism, and (b) this predictive utility is not moderated by LTI status, and is based in part on ostensibly dynamic risk factors. Implications for informing parole decision-making and risk management for LTIs are discussed.