Community reentry: Racial/ethnic differences in unmet needs among adults with co-occurring opioid use and mental health disorder.

BACKGROUND: Adults with co-occurring opioid use and mental health disorder (COD) recently released from incarceration have many social and health needs that place them at the most significant risk for overdose and poor reentry outcomes. Little is known about racial/ethnic differences in this population. METHODS: To examine racial/ethnic differences in social and health needs, data were analyzed for 293 adults with COD within two weeks of release, a high-risk period for overdose, from six Massachusetts jails. RESULTS: Overall, participants (62.6% non-Hispanic White, 23.1% Hispanic, 14.3% non-Hispanic Black, and 73.5% male) reported multiple health and social needs across groups. Chi-square tests and Kruskal-Wallis one-way ANOVAs were used to compare social and health needs among racial/ethnic groups. Non-Hispanic Black participants reported more problems with crack/cocaine, whereas Non-Hispanic White and Hispanic participants reported more problems with opioids (p < .001). Despite similar lifetime rates of illicit substance use, non-Hispanic Black and Hispanic participants received less treatment (p < .001). Non-Hispanic White participants reported more opioid and alcohol use (p < .006), trauma symptoms (p = .020), utilization of behavioral health treatment (p = .008), and more medical needs than Hispanic and/or non-Hispanic Black participants (p = .001). Non-Hispanic Black and Hispanic participants reported more needs related to social determinants of health (p = .008). CONCLUSIONS: While re-entry is a vulnerable period for all adults with COD, this paper identifies specific needs by race/ethnicity and proposes strategies to advance equity and improve care for all formerly incarcerated adults with a COD.

Racial and ethnic differences in behavioral health, criminal legal system involvement, and service needs among mental health court participants: Implications for service delivery.

Mental Health Courts (MHCs), an alternative to incarceration, aim to address behavioral health, social needs, and criminal recidivism and serve many adults with co-occurring mental health and substance use disorder (COD). Despite the growth in MHCs, little research has examined ethnic/racial differences in behavioral health and service needs of individuals with COD. This study used data from behavioral health and social assessments administered to 146 adults with COD entering a Massachusetts MHC. Multivariate linear and logistic regression controlling for key demographics tested differences between racial/ethnic groups on current and lifetime substance use, mental health symptoms, and history of criminal legal system involvement. Hispanic participants were more likely than non-Hispanic White participants to report current and lifetime serious mental illness and lifetime Emergency Department (ED) mental health treatment. Non-Hispanic White participants were more likely to report current and lifetime use of illicit substances, more recent outpatient and overall lifetime treatment attempts for substance use, and higher number of lifetime arrests compared to non-Hispanic Black participants. Lastly, non-Hispanic White participants also reported more recent outpatient and overall lifetime treatment attempts for substance use compared to Hispanic participants. Racial/ethnic differences in behavioral health and social needs of MHC enrollees with COD exist and should be considered in the planning and delivery of psychological and social services. Understanding the diverse population of new MHC enrollees is an important first step in identifying and addressing racial and ethnic disparities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Substance use treatment services utilization and outcomes among probationers in drug courts compared to a matched cohort of probationers in traditional courts.

BACKGROUND AND OBJECTIVES: Drug courts provide an array of substance use treatments and community-based services for probationers struggling with substance use disorders. We assessed substance use treatment services utilization and related expenditures and relapse and recidivism outcomes and identified predictors of cost of provision of substance use treatment services in a matched cohort of Massachusetts probationers in drug courts and traditional courts. METHODS: This was an observational quasi-experimental study with 542 propensity-score-matched probationers initiating drug court between August 1, 2015 and February 28, 2018 and a minimum 6-month follow-up period. RESULTS: A significantly greater proportion of probationers in drug courts were female, self-reported opioids as their primary drug of choice, had a history of substance use treatment, and a high and very high risk of recidivism than their counterparts in traditional courts. We estimated that the provision of substance use treatment services was $1498 more expensive for probationers in drug courts than traditional courts (p = .054). There were no statistically significant differences in relapse or recidivism rates between court systems. DISCUSSION AND CONCLUSIONS: Probationer's age, gender, risk of recidivism at court intake, and enrollment length were strong predictors of expenditures on substance use treatment services. SCIENTIFIC SIGNIFICANCE: This was the first study to assess substance use treatment services utilization and outcomes among probationers in drug courts and traditional courts. Drug courts served the needs of probationers disproportionally impacted by nonserious drug-related offenses struggling with substance use disorders who were at a high and very high risk of recidivism at court intake.

Risk-need-responsivity: Evaluating need-to-service matching with reach, effectiveness, adoption, implementation, maintenance.

With a sample of 125 adults under community supervision (71.20% male, 76.00% White, mean age = 33.17 years), this study evaluated need-to-service matching using an evaluation framework from implementation science. Need-to-service matching is a case management strategy intended to align service referrals in case plans with justice-involved persons' criminogenic needs. The results indicated that need-to-service matching reached a high percentage of its target population at 81.70%. Within criminogenic need areas, good match frequencies ranged from 80.00% in family/marital problems to 98.29% in alcohol/drug problems. Clinical staff also met the adherence benchmark applied by the current study, which required a 75.00% match between individuals' criminogenic needs and the services they received. Justice-involved persons had, on average, 90.46% of their criminogenic needs matched with at least one service referral. Over-prescription of services (i.e., recommendation of services that were not needed) was high, with frequencies in need areas ranging from 60.98% in education/employment to 82.21% in antisocial patterns. Methods from implementation science are useful for structuring evaluations of need-to-service matching, understanding implementation success and failure, and generating recommendations for improving implementation practice. The field would benefit greatly from benchmarks for need-to-service matching evaluation elements.

Implementation of risk-need-responsivity principles into probation case planning.

OBJECTIVE: Research indicates moderate-to-limited integration of the risk-need-responsivity (RNR) principles in probation case planning. Efforts to improve implementation are important targets for research, policy, and practice. This study examined the ability of two juvenile probation departments to implement RNR principles with fidelity following a comprehensive implementation protocol that included RNR-related policies, creation of a service matrix for criminogenic need-to-service matching, and extensive staff training. HYPOTHESES: The researchers anticipated fidelity to the risk and need principles would be stronger than previous studies. METHOD: This implementation study involved secondary data analysis of services received over 10 months for 254 adolescent offenders (76.80% male, 72.40% White, M age = 16.13 years) from two probation departments following adoption of the Youth Level of Service/Case Management Inventory. RESULTS: Probation departments evidenced strong fidelity to the risk principle, such that higher risk youth were assigned more services with higher intensity. Fidelity to the need principle was moderate at best (an average 24.61% to 29.38% need-to-service match) and varied by criminogenic need, overall risk level, and the operational definition of criminogenic need. CONCLUSIONS: Comprehensive implementation practices are associated with strong fidelity to the risk principle, but it may take longer for probation departments to achieve strong fidelity to the need principle. Researchers should identify more feasible methods for implementing the need principle and strive for a consensus on methods for measuring need-to-service match that are also consistent with probation policies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The validity of risk assessment instruments for transition-age youth.

OBJECTIVE: There is increasing recognition in the justice system that transition-age youth (TAY) are in a unique developmental period that may require tailored policies and practices. This study investigated the differential predictive validity and potential for disparate impact of both juvenile (the Structured Assessment of Violence Risk for Youth and Youth Level of Service/Case Management Inventory) and adult risk assessment instruments (the Historical-Clinical-Risk Management-20 [HCR-20] and the Violence Risk Appraisal Guide [VRAG]) with this age group (ages 16-24), relative to adolescents (ages 12-15) or older adults (ages 25-40). METHOD: The authors obtained secondary data sets for the 4 instruments totaling 3,353 cases. The final samples for each instrument after exclusions ranged from 1,181 cases for the VRAG to 290 cases for the HCR-20. RESULTS: Age group generally did not moderate the prediction of any recidivism or of violent recidivism. The only exception was on the HCR-20, which significantly predicted recidivism regardless of age but operated better for TAY than adults. The VRAG was the only instrument with significant mean age-related differences in risk scores. CONCLUSIONS: The potential for an unfair impact of risk assessments on TAY is minimal regardless of whether they are processed in the juvenile or adult justice systems. This preliminary evidence suggests well-validated instruments used in either system should accurately quantify the likelihood of recidivism for TAY; however, this does not necessarily translate into effective risk management for this developmental period. More research using study designs developed specifically for examining age-related differences is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).