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Zampella B, Talton S, Lam J, Khan A, Bryant T, Kunz M. Assertive community treatment as an alternative to incarceration for American pretrial detainees. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 94:101990. [PMID: 38663174 DOI: 10.1016/j.ijlp.2024.101990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/21/2024] [Accepted: 04/17/2024] [Indexed: 06/15/2024]
Abstract
In the United States and elsewhere around the world, people with serious mental illness (SMI) are overrepresented in the criminal justice system. Clinical interventions to divert such individuals out of correctional settings, including Assertive Community Treatment (ACT), have been shown to reduce rates of criminal justice recidivism when modified to allow for the use of court sanctions to encourage treatment adherence. However, these interventions are noted to be underutilized as alternative to incarceration (ATI) programs. This paper summarizes the results of a retrospective cohort study conducted in a New York State forensic psychiatric hospital of 87 pretrial detainees admitted after being found incompetent to stand trial between January 2019 and January 2022. Of these, 49 patients were referred to an ACT team that served as an ATI program. The study outcomes noted that patients referred to this ACT team were 20% less likely to remain in pretrial detention than those that were not. Moreover, patients referred to the ACT program were also 34% more likely to be granted an ATI plea bargain in the community that did not involve serving a prison term. These results suggest that pretrial detainees with SMI are more likely to be granted an ATI program that offers more intensive treatment services such as ACT, due to the capability of such programs to also provide more intensive outreach and community supervision than traditional outpatient mental health service providers.
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Affiliation(s)
- Brian Zampella
- Kirby Forensic Psychiatric Center, New York State Office of Mental Health, United States of America; New York University, Silver School of Social Work, United States of America.
| | - Simone Talton
- Kirby Forensic Psychiatric Center, New York State Office of Mental Health, United States of America.
| | - Jonathan Lam
- Kirby Forensic Psychiatric Center, New York State Office of Mental Health, United States of America; New York University Grossman, School of Medicine, United States of America; Teacher's College, Columbia University, United States of America.
| | - Anzalee Khan
- Nathan Kline Institute for Psychiatric Research, New York State Office of Mental Health, United States of America.
| | - Tuborah Bryant
- Kirby Forensic Psychiatric Center, New York State Office of Mental Health, United States of America.
| | - Michal Kunz
- Kirby Forensic Psychiatric Center, New York State Office of Mental Health, United States of America; New York University Grossman, School of Medicine, United States of America.
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Maeng D, Tsun ZY, Lesch E, Jacobowitz DB, Strawderman RL, Harrington DK, Li Y, Weisman RL, Lamberti JS. Affordability of Forensic Assertive Community Treatment Programs: A Return-on-Investment Analysis. Psychiatr Serv 2023; 74:358-364. [PMID: 36065582 DOI: 10.1176/appi.ps.20220186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In this study, the authors assessed return on investment (ROI) associated with a forensic assertive community treatment (FACT) program. METHODS A retrospective secondary data analysis of a randomized controlled trial comprising 70 legal-involved patients with severe mental illness was conducted in Rochester, New York. Patients were randomly assigned to receive either FACT or outpatient psychiatric treatment including intensive case management. Unit of service costs associated with psychiatric emergency department visits, psychiatric inpatient days, and days in jail were obtained from records of New York State Medicaid and the Department of Corrections. The total dollar value difference between the two trial arms calculated on a per-patient-per-year (PPPY) basis constituted the return from the FACT intervention. The FACT investment cost was defined by the total additional PPPY cost associated with FACT implementation relative to the control group. ROI was calculated by dividing the return by the investment cost. RESULTS The estimated return from FACT was $27,588 PPPY (in 2019 dollars; 95% confidence interval [CI]=$3,262-$51,913), which was driven largely by reductions in psychiatric inpatient days, and the estimated investment cost was $18,440 PPPY (95% CI=$15,215-$21,665), implying an ROI of 1.50 (95% CI=0.35-2.97) for FACT. CONCLUSIONS The Rochester FACT program was associated with approximately $1.50 return for every $1 spent on its implementation, even without considering potential returns from other sources, including reductions in acute medical care, crime-related damages, and public safety costs. ROI estimates were highly dependent on context-specific factors, particularly Medicaid reimbursement rates for assertive community treatment and hospital stays.
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Affiliation(s)
- Daniel Maeng
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Zhi-Yang Tsun
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Eric Lesch
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - David B Jacobowitz
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Robert L Strawderman
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Donald K Harrington
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Yue Li
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Robert L Weisman
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - J Steven Lamberti
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
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Costigan CL, Woodin EM, Duerksen KN, Ferguson R. Benefits and Drawbacks of Police Integration Into Assertive Community Treatment Teams. Psychiatr Serv 2022; 73:447-455. [PMID: 34615367 DOI: 10.1176/appi.ps.201900549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Assertive community treatment (ACT) teams provide outreach services to individuals coping with severe mental illness. Because such individuals are at increased risk for involvement with law enforcement, a model that integrates police officers into ACT teams (ACT-PI) was developed for ACT teams serving clients with or without forensic involvement. The goal of this study, conducted in British Columbia, was to evaluate the benefits and drawbacks of the ACT-PI model. METHODS Qualitative semistructured interviews were conducted with 21 ACT-PI clients (in 2017) and 22 ACT-PI staff (in 2018). Thematic analyses identified key themes related to the benefits and drawbacks of officer integration into the ACT-PI model. RESULTS Perceived benefits of police integration were opportunities for relationship building between officers and clients, improved safety, more holistic care due to embeddedness (i.e., effective interagency collaboration between police and health care providers), the prevention of future problems, and police officers' authority enhancing compliance. Perceived drawbacks included risk for legal consequences, stigma from police interaction, escalating distress of clients, low officer availability, and the risk for changing the nature of ACT teams. CONCLUSIONS Participants reported that the model of officer integration into ACT-PI teams may improve both client and staff well-being. In some communities, and with certain precautions, ACT-PI may be a viable model for ACT teams serving clients with and clients without a history of forensic involvement.
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Abstract
PURPOSE OF REVIEW We reviewed the existing and recent community models of care in schizophrenia. We examine characteristics, recent updates, evidence, cost-effectiveness, and patients' acceptance for existing and new community-based care models in high-income (HI) and low- and middle-income (LAMI) countries. RECENT FINDINGS Assertive Community Treatment (ACT), Intensive Case Management (ICM), and Crisis Intervention are cost-effective interventions for schizophrenia and time tested in the last few decades in HI countries. The growing evidence suggests that tailor-made ACTs and ICM can effectively reduce substance use, homelessness, and criminal activity in persons with schizophrenia who live in the community. Similarly, in LAMI Countries, a few community-based care models for schizophrenia have been developed and tested based on community-based rehabilitation principles. The modality of a community model of care and interventions for a person with schizophrenia should be chosen based on the person's co-existing psychosocial difficulties and challenges such as homelessness, criminal behaviour, and substance use.
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Affiliation(s)
- Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029 India
| | - Mohan K. Isaac
- Clinical Professor of Psychiatry, Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Fremantle Hospital, Fremantle Hospital, Level 7, T Block, Fremantle, WA 6160 Australia
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Marquant T, Van Nuffel M, Sabbe B, Goethals K. Substance Use Disorders as a Critical Element for Decision-Making in Forensic Assertive Community Treatment: A Systematic Review. Front Psychiatry 2021; 12:777141. [PMID: 34950071 PMCID: PMC8688775 DOI: 10.3389/fpsyt.2021.777141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: The prevalence of substance use disorders in forensic populations is high. They are an important factor linked to negative outcomes in mentally ill offenders and are detrimental to forensic or non-forensic outcome measures. In contrast, substance use disorders are often underdiagnosed and undertreated, especially in forensic settings. Forensic Assertive Community Treatment is a forensic adaptation of regular assertive community treatment, combined with essential elements of forensic rehabilitation theories. Little is known however on the effectivity of forensic assertive community treatment when it comes to substance use disorders or what their exact role is on the outcome measures. In this paper, we explore how SUD is treated in Forensic assertive community treatment and how it relates to the forensic and non-forensic outcome measures. Methods: We performed a systematic review (PRISMA) of forensic Assertive community treatment teams that followed the main evidence-based principles of regular assertive community treatment and added basic elements of forensic rehabilitation. We analyzed articles the Psychinfo and Medline databases dating from 2005 to 2020. Fifteen studies fit the search criteria and were included in the analysis. The Quality of the studies was assessed using the Newcastle-Ottawa scale. Results: SUD was highly prevalent in all studies. Patients entered FACT through two pathways, either from a care continuum or directly from prison. The severity of SUD at intake emerges as a critical element when deciding which pathway to choose, as a high severity-score at the start of FACT follow-up was linked to recidivism. While differing in method all studies offered integrated SUD treatment. These included evidence-based techniques like CBT, therapeutic communities, and Substance Abuse Management Module. Though results on SUD outcomes were mixed 4 studies mentioned abstinence in 50-75%. The severity of SUD tended to increase initially and to stabilize afterwards. Conclusion: Severity of SUD at intake emerges as a decisive element in decision-making on entering FACT teams directly from prison or through a care-continuum. The ways to provide SUD treatment varied and outcomes for SUD were mixed. SUD was found to be detrimental to forensic and non-forensic outcome measures, such as recidivism or hospitalizations during FACT treatment.
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Affiliation(s)
- Thomas Marquant
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute, Antwerp, Belgium
- Department of Forensic Psychiatry, Fivoor, Rotterdam, Netherlands
- Department of Justice, Brussels, Belgium
| | | | - Bernard Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute, Antwerp, Belgium
- Department of Psychiatry, Antwerp University, Antwerp, Belgium
- Department of Psychiatry, Antwerp University Hospital, Antwerp, Belgium
| | - Kris Goethals
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute, Antwerp, Belgium
- Department of Psychiatry, Antwerp University, Antwerp, Belgium
- Department of Psychiatry, Antwerp University Hospital, Antwerp, Belgium
- Department of Forensic Psychiatry, University Forensic Center, Antwerp, Belgium
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Paradis-Gagné E, Holmes D. Gilles Deleuze's societies of control: Implications for mental health nursing and coercive community care. Nurs Philos 2021; 23:e12375. [PMID: 34724314 DOI: 10.1111/nup.12375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/14/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
Since the era of deinstitutionalisation, many clinical approaches have emerged to enable the care and treatment of people suffering from mental illness. In recent years, the use of coercive approaches in the community (e.g., outpatient commitment or community treatment orders) has also increased internationally. Although nurses' role regarding these coercive approaches is central and significant, few empirical and theoretical writings have tackled this controversial nursing practice. The purpose of this paper is to analyse coercive nursing care through the lens of French philosopher Gilles Deleuze's concept of 'societies of control'. Taking up Michel Foucault's work on disciplinary power, Deleuze explores how the move from the striated spaces of closed institutions to the smooth spaces of societies of control took place since the middle of the 20th century. According to Deleuze, the overall objective of 'societies of control' is no longer simply to govern deviant behaviour in closed environments (e.g., psychiatric hospitals and prisons) but to ensure a regime of unrelentless surveillance in the open spaces of our communities.
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Affiliation(s)
| | - Dave Holmes
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Lamberti JS, Katsetos V, Jacobowitz DB, Weisman RL. Psychosis, Mania and Criminal Recidivism: Associations and Implications for Prevention. Harv Rev Psychiatry 2021; 28:179-202. [PMID: 32251070 DOI: 10.1097/hrp.0000000000000251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
People with mental illness are overrepresented throughout the criminal justice system, including jail, prison, probation, and parole populations. Yet much disagreement remains about why this problem exists and how best to address it. This article specifically examines empirical evidence regarding the question of whether psychosis and mania are associated with criminal recidivism, and whether this association is predictive or causal in nature. Review of the current literature suggests that psychotic and manic symptoms are associated with increased likelihood of arrest and incarceration. In addition, current evidence shows that pharmacotherapy can reduce criminal recidivism among justice-involved adults with psychosis or mania. However, the extent to which the association between psychosis, mania, and criminal justice system involvement is causal remains uncertain. Also, the literature suggests that most crimes committed by people with schizophrenia spectrum disorders or bipolar I disorder may be driven by factors other than their psychotic or manic symptoms. These established "criminogenic needs" are more common among people with severe mental disorders than in the general population. For optimal prevention, those who serve justice-involved adults with psychosis or mania in community settings should consider addressing the full range of factors that potentially drive their criminal justice system involvement.
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Affiliation(s)
- J Steven Lamberti
- From the Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
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8
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Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:• Assess characteristics of forensic assertive community treatment programs. ABSTRACT Forensic assertive community treatment (FACT) has emerged internationally as an intervention strategy for people with serious mental disorders who are involved with the criminal justice system. Studies to date have shown marked variability, however, in FACT program design and operation. Based upon a literature review and relevant experience, the authors present their perspective on the essential elements of FACT. Given that FACT is an adaptation of the evidence-based assertive community treatment (ACT) model, it is recommended that FACT programs maintain a high-fidelity ACT component. FACT programs should also have both mental health and criminal justice admission criteria because service recipients are involved in both service systems. For optimal effectiveness, FACT team clinicians must partner with criminal justice agencies that provide community-based supervision to their patients. Prospective FACT enrollees should receive a clear explanation of the program, including how their respective mental health and criminal justice service providers will work collaboratively with them to prevent incarceration. FACT programs should also use risk/need assessment to inform treatment planning, evidence-based mental health and community correctional practices to promote both wellness and public safety, and shared training to promote effective collaboration. Additional elements to consider include housing, medical care, and transitional services. These elements are presented and discussed, including a rationale and evidence to support each component. The article concludes with introduction of a FACT fidelity scale, the Rochester Forensic Assertive Community Treatment Scale (R-FACTS). By operationalizing essential FACT elements, the R-FACTS is designed to support FACT program development, implementation, and dissemination in a more consistent and measurable manner.
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Stanton J, Thomas DR, Jarbin M, MacKay P. Self-determination theory in acute child and adolescent mental health inpatient care. A qualitative exploratory study. PLoS One 2020; 15:e0239815. [PMID: 33064721 PMCID: PMC7567378 DOI: 10.1371/journal.pone.0239815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction There is a dearth of research to guide acute adolescent mental health inpatient care. Self-determination Theory provides evidence that meeting needs for relatedness, autonomy and competence is likely to increase wellbeing and intrinsic motivation. These needs may be able to be met in the inpatient environment. Method This qualitative study aimed to explore young people’s experience of acute mental health inpatient care with particular attention to meeting of these three needs. Fifteen young people were interviewed. The importance of relatedness with staff, other young people and families was identified. Results Relatedness with staff and peers were valued parts of admission. Some young people describe enhanced relatedness with family. They described loss of autonomy as a negative experience but appreciated opportunities to be involved in choices around their care and having more freedom. Coming into hospital was associated with loss of competence but they described building competence during the admission. Engaging in activities was experienced positively and appeared to enhance meeting of all three needs. Meeting of the three needs was associated with an experience of increased safety. Conclusions Engaging young people in activities with a focus on relatedness, autonomy and competence may have specific therapeutic potential. Autonomy, experience of competence and connection with staff may enhance safety more effectively than physical containment. Peer contact may have untapped therapeutic value we understand little of. This study supports the value of Self-determination Theory as a guide day to day inpatient care to meet the needs of adolescents for relatedness, autonomy and competence.
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Affiliation(s)
- Josephine Stanton
- Child and Family Unit, Auckland District Health Board, Auckland, New Zealand
| | - David R Thomas
- Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Maarten Jarbin
- Faculty of Medicine and Health Sciences, Linkoping University, Linkoping, Sweden
| | - Pauline MacKay
- Child and Family Unit, Auckland District Health Board, Auckland, New Zealand
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Simms-Sawyers C, Miles H, Harvey J. An exploration of perceived coercion into psychological assessment and treatment within a low secure forensic mental health service. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2020; 27:578-600. [PMID: 33679199 PMCID: PMC7901700 DOI: 10.1080/13218719.2020.1734981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Psychologists working within forensic mental health (FMH) services face challenges around supporting clients' informed consent when engaging in psychological assessment and treatment. Given that there is little research in this area, this qualitative study interviewed ten forensic inpatients from a low secure FMH service, to determine the impact of any perceived coercion to engage with psychologists. Interviews were transcribed and subject to Thematic Analysis. Three over-arching themes emerged from the analysis: 'Awareness of Coercive Power', 'Experiencing and Responding to Coercion' and 'Psychological Treatment is Helpful, But…'. Participants perceived coercion to engage with psychologists. Perceived coercion led to psychological distress, wanting to resist, and superficial engagement. Despite this, therapeutic alliance was established with the psychologist but the quality of the therapeutic alliance was compromised. The findings have implications for psychologists working in FMH services. Suggestions for reducing perceived coercion and future directions for research are discussed.
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Affiliation(s)
| | - Helen Miles
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Kent Forensic & Specialist Care Group, Kent & Medway NHS & Social Care Partnership Trust (KMPT) & Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Joel Harvey
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Cuddeback GS, Simpson JM, Wu JC. A comprehensive literature review of Forensic Assertive Community Treatment (FACT): Directions for practice, policy and research. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1717054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Gary S. Cuddeback
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Juliet C. Wu
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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12
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Garcia RA, Kenyon KH, Brolan CE, Coughlin J, Guedes DD. Court as a health intervention to advance Canada's achievement of the sustainable development goals : a multi-pronged analysis of Vancouver's Downtown Community Court. Global Health 2019; 15:80. [PMID: 31847875 PMCID: PMC6918572 DOI: 10.1186/s12992-019-0511-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/21/2019] [Indexed: 12/04/2022] Open
Abstract
Background The increase in problematic substance use is a major problem in Canada and elsewhere, placing a heavy burden on health and justice system resources given a spike in drug-related offences. Thus, achievement of Sustainable Development Goal (SDG) Target 3.5 to ‘Strengthen the prevention and treatment of substance abuse’ is important for Canada’s overall realization of the SDGs, including SDG 3 (Good Health and Wellbeing). Since 2008, Vancouver’s Downtown Community Court (DCC) has pioneered an innovative partnership among the justice, health and social service systems to address individuals’ needs and circumstances leading to criminal behaviour. While researchers have examined the DCC’s impact on reducing recidivism, with Canada’s SDG health commitments in mind, we set out to examine the ways health and the social determinants of health (SDH) are engaged and framed externally with regard to DCC functioning, as well as internally by DCC actors. We employed a multi-pronged approach analyzing (1) publicly available DCC documents, (2) print media coverage, and (3) health-related discourse and references in DCC hearings. Results The documentary analysis showed that health and the SDH are framed by the DCC as instrumental for reducing drug-related offences and improving public safety. The observation data indicate that judges use health and SDH in providing context, understanding triggers for offences and offering rationale for sentencing and management plans that connect individuals to healthcare, social and cultural services. Conclusions Our study contributes new insights on the effectiveness of the DCC as a means to integrate justice, health and social services for improved health and community safety. The development of such community court interventions, and their impact on health and the SDH, should be reported on by Canada and other countries as a key contribution to SDG 3 achievement, as well as the fulfillment of other targets under the SDG framework that contain the SDH. Consideration should be given by Canada as to how to capture and integrate the important data generated by the DCC and other problem-solving courts into SDG reporting metrics. Certainly, the DCC advances the SDGs’ underlying Leave No One Behind principle in a high-income country context.
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Affiliation(s)
| | | | - Claire E Brolan
- Centre for Policy Futures, University of Queensland, Brisbane, Australia
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Browne C, Brown G, Smith IC. Adapting dialectical behaviour therapy in forensic learning disability services: A grounded theory informed study of "what works". JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:792-805. [PMID: 30687987 DOI: 10.1111/jar.12569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/18/2018] [Accepted: 01/06/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Emerging evidence indicates effectiveness of dialectical behaviour therapy (DBT) for people with intellectual disabilities (PWID) in forensic settings; however, little is known about "what works" facilitating engagement and change. METHODS Eleven interviews were conducted with nine service users across two secure inpatient services. Grounded theory was used to develop a model of perceived engagement and change. RESULTS The model provides insights into how change occurs during DBT delivered in forensic settings. DBT constitutes a challenging journey, yet provides the motivation and means to address individual's intra-/interpersonal aggression and progress towards release. Participants experienced engaging with DBT as difficult and coercive, moving from compliance and avoidance to acceptance and change. Key factors included participants' motivation, beliefs about safety and ability to change, and interactions with staff. CONCLUSION Recommendations are made for increasing intrinsic motivation, reducing perceived coercion and distress, and for future research to address potential aversive elements and enhance effectiveness.
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Affiliation(s)
- Claire Browne
- Clinical Psychology Programme, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Gill Brown
- Clinical Psychology Programme, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ian C Smith
- Clinical Psychology Programme, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Wilson JL, Bandyopadhyay S, Yang H, Cerulli C, Morse DS. IDENTIFYING PREDICTORS OF SUBSTANCE USE AND RECIDIVISM OUTCOME TRAJECTORIES AMONG DRUG TREATMENT COURT CLIENTS. CRIMINAL JUSTICE AND BEHAVIOR 2018; 45:447-467. [PMID: 33060870 PMCID: PMC7556699 DOI: 10.1177/0093854817737806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Drug treatment court (DTC) is a diversion program for individuals with drug-related crimes. However, the DTC literature is conflicting with regard to substance use and recidivism outcomes. This study examines factors associated with improved client outcome trajectories among a multisite, national DTC sample. We conducted a secondary analysis of 2,295 participants using the Global Appraisal of Individual Needs assessment tool. Participants in community-based treatment comprised a nonequivalent comparison group. Zero-inflated Poisson (ZIP) regression examined client sociodemographics in relation to substance use and rearrest at 6-month follow-up. Employed DTC clients were more likely to abstain from substances, but among all study participants, higher baseline use, male gender, and employment predicted substance use. Similarly, among DTC clients, older age and employment predicted no rearrests, but among all study participants, older and employed individuals had worse arrest outcome trajectories. Future work is needed to better understand how client characteristics may inform individualized treatment approaches.
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Jager F, Perron A. Caring as Coercion: Exploring the Nurse's Role in Mandated Treatment. JOURNAL OF FORENSIC NURSING 2018; 14:148-153. [PMID: 30130315 DOI: 10.1097/jfn.0000000000000207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
When nurses work in environments that have overlapping medical, legal, institutional, social, and therapeutic priorities, nursing care can become an effective tool in advancing the competing goals of these multiple systems. During the provision of patient care, nurses manage the tensions inherent in the competing priorities of these different systems, and skillful nursing can have the effect of rendering these tensions invisible. This puts nurses in an ethically complex position, where on one hand, their humanizing empathy has the potential to improve the delivery and effect of mandated care yet, on the other hand, their skillfulness can render invisible the weaknesses in medicolegal structures. In this article, we present a composite case study as a vehicle to illustrate the way this dilemma manifests in day-to-day nursing interactions and explore the potential of microethics to inform the everyday decisions of nurses delivering care-as-coercion.
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Affiliation(s)
- Fiona Jager
- Faculty of Health Sciences, School of Nursing, University of Ottawa
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Lamberti JS, Weisman RL, Cerulli C, Williams GC, Jacobowitz DB, Mueser KT, Marks PD, Strawderman RL, Harrington D, Lamberti TA, Caine ED. A Randomized Controlled Trial of the Rochester Forensic Assertive Community Treatment Model. Psychiatr Serv 2017; 68:1016-1024. [PMID: 28566028 PMCID: PMC7369621 DOI: 10.1176/appi.ps.201600329] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Forensic assertive community treatment (FACT) is an adaptation of the assertive community treatment model and is designed to serve justice-involved adults with serious mental illness. This study compared the effectiveness of a standardized FACT model and enhanced treatment as usual in reducing jail and hospital use and in promoting engagement in outpatient mental health services. METHODS Seventy adults with psychotic disorders who were arrested for misdemeanor crimes and who were eligible for conditional discharge were recruited from the Monroe County, New York, court system. Participants were randomly assigned to receive either FACT (N=35) or enhanced treatment as usual (N=35) for one year. Criminal justice and mental health service utilization outcomes were measured by using state and county databases. RESULTS Forty-nine participants (70%) completed the full one-year intervention period. Nineteen (27%) were removed early by judicial order, one was removed by county health authorities, and one died of a medical illness. Intent-to-treat analysis for all 70 participants showed that those receiving the FACT intervention had fewer mean±SD convictions (.4±.7 versus .9±1.3, p=.023), fewer mean days in jail (21.5±25.9 versus 43.5±59.2, p=.025), fewer mean days in the hospital (4.4±15.1 versus 23.8±64.2, p=.025), and more mean days in outpatient mental health treatment (305.5±92.1 versus 169.4±139.6, p<.001) compared with participants who received treatment as usual. CONCLUSIONS The Rochester FACT model was associated with fewer convictions for new crimes, less time in jail and hospitals, and more time in outpatient treatment among justice-involved adults with psychotic disorders compared with treatment as usual.
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Affiliation(s)
- J Steven Lamberti
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Robert L Weisman
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Catherine Cerulli
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Geoffrey C Williams
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - David B Jacobowitz
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Kim T Mueser
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Patricia D Marks
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Robert L Strawderman
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Donald Harrington
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Tara A Lamberti
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Eric D Caine
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
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Heilbrun K, Pietruszka V, Thornewill A, Phillips S, Schiedel R. Diversion at re-entry using criminogenic CBT: Review and prototypical program development. BEHAVIORAL SCIENCES & THE LAW 2017; 35:562-572. [PMID: 28913841 DOI: 10.1002/bsl.2311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/19/2017] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Abstract
Society and the criminal justice system prioritize the reduction of reoffending risk as part of any criminal justice intervention. The Sequential Intercept Model identifies five points of interception at which justice-involved individuals can be diverted into a more rehabilitative alternative: (1) law enforcement/emergency services; (2) booking/initial court hearings; (3) jails/courts; (4) re-entry; and (5) community corrections/community support. The present article focuses on diversion as part of Intercept 5 - re-entry planning and specialized services in the community. We describe the challenges associated with diversion at this stage, and review the relevant research. Next, we describe a "criminogenic cognitive behavioral therapy" project that has been developed and implemented as part of a federal re-entry court. Finally, we discuss the implications of the challenges of intervention at this stage, and the recently developed "Re-entry Project," for research, policy, and practice.
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Affiliation(s)
- Kirk Heilbrun
- Department of Psychology, Drexel University, Philadelphia, PA, U.S.A
| | | | - Alice Thornewill
- Department of Psychology, Drexel University, Philadelphia, PA, U.S.A
| | - Sarah Phillips
- Department of Psychology, Drexel University, Philadelphia, PA, U.S.A
| | - Rebecca Schiedel
- Department of Psychology, Drexel University, Philadelphia, PA, U.S.A
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Landess J, Holoyda B. Mental health courts and forensic assertive community treatment teams as correctional diversion programs. BEHAVIORAL SCIENCES & THE LAW 2017; 35:501-511. [PMID: 28891121 DOI: 10.1002/bsl.2307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/25/2017] [Accepted: 06/30/2017] [Indexed: 06/07/2023]
Abstract
Problem-solving courts (PSCs) developed as a means of mandating treatment and judicial supervision of certain types of court participants. PSCs have rapidly expanded in number and type over several decades. Mental health courts (MHCs) are a type of PSC that arose in response to the growing number of persons with mental illness within the criminal justice system. Their primary role is to divert individuals with mental illness from incarceration into psychiatric treatment and to reduce recidivism while improving psychosocial functioning of participants. Although different in history, philosophy, and program structure, forensic assertive community treatment (FACT) programs serve a similar goal of reducing recidivism and improving functioning in persons with mental illness who are involved with the criminal justice system. FACTs may be used as a standalone diversion option or be linked with a MHC as a form of intensive treatment and monitoring. Suggestions for future research and evaluation of these programs are offered.
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Affiliation(s)
- Jacqueline Landess
- Department of Psychiatry and Neuroscience, Division of Forensic Psychiatry, Saint Louis University School of Medicine, St Louis, MO, U.S.A
| | - Brian Holoyda
- Department of Psychiatry and Neuroscience, Division of Forensic Psychiatry, Saint Louis University School of Medicine, St Louis, MO, U.S.A
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Quinn CR, Liu C, Kothari C, Cerulli C, Thurston SW. Psychological Distress Among Youth Probationers: Using Social Determinants of Health to Assess Suicidal Thoughts and Behaviors. ADOLESCENT PSYCHIATRY 2017; 7:89-104. [PMID: 30498679 DOI: 10.2174/2210676607666170317143345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background For youth probationers, it is important to understand how mental health and substance use predict their suicidal thoughts and behaviors (STB) to identify interventions to reduce their psychological distress. Objective In this study, risk and protective factor indicators based on the Youth Assessment and Screening Instrument (YASI) Full Assessment were used to explore STB of youth probationers. The study's overarching aim was to examine the associations of psychological distress and other risk and protective factors with youth probationers' STB based on a Social Determinants of Health framework. Method This cross-sectional secondary analysis reviewed YASI records from a sample of 11,607 probationers of age 12-18 years within a large urban setting. Results The study used logistic regression models to assess risk and protective factors for STB odds (5.79%, n = 672 positive endorsement). African Americans were less likely to report STB, and girls were much more likely than boys to report STB across risk factors. Mental health disorders and substance use increased STB risk. Conclusion The findings underscore the need for screening and treatment of psychological distress for youth probationers. This study discussed these findings, strengths and limitations, and directions for future research.
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Affiliation(s)
- Camille R Quinn
- The Ohio State University, College of Social Work, Ohio, USA
| | - Chang Liu
- Department of Biostatistics and Computational Biology, School of Medicine & Dentistry, University of Rochester Medical Center, USA
| | - Catherine Kothari
- Homer Stryker MD School of Medicine Division of Epidemiology and Biostatistics, Biomedical Sciences Department, Western Michigan University, Michigan, USA
| | - Catherine Cerulli
- Department of Psychiatry, School of Medicine & Dentistry & University of Rochester Susan B. Anthony Center, NY, USA
| | - Sally W Thurston
- Department of Biostatistics and Computational Biology, School of Medicine & Dentistry, University of Rochester Medical Center, USA
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Marquant T, Sabbe B, Van Nuffel M, Goethals K. Forensic Assertive Community Treatment: A Review of the Literature. Community Ment Health J 2016; 52:873-881. [PMID: 27422650 DOI: 10.1007/s10597-016-0044-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 07/08/2016] [Indexed: 11/27/2022]
Abstract
An extensive body of literature provides evidence supporting the effectiveness of assertive community treatment (ACT) with regard to non-forensic outcome measures, such as number of hospital admissions and length of stay. However, research findings on the effectiveness of ACT for forensic outcome measures, such as rearrests or detentions, is much less clear. The present review, therefore, focuses on the application of ACT in forensic populations, combining key elements of ACT with elements of forensic rehabilitation models. Specifically, a review of the literature was conducted using a systematic methodology in an attempt to combine evidence-based elements of 40 years of research on regular ACT with elements of forensic rehabilitation models. Results reveal limited yet promising evidence in support of the effectiveness of forensic ACT for forensic outcome measures. Implications for future research and clinical practice are discussed.
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Affiliation(s)
- Thomas Marquant
- Collaborative Antwerp Psychiatric Research institute (CAPRI), Campus Drie Eiken Universiteitsplein 1, 2610, Antwerp, Belgium.
- UPC St Camillus Bierbeek, Krijkelberg 1, 3360, Bierbeek, Belgium.
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research institute (CAPRI), Campus Drie Eiken Universiteitsplein 1, 2610, Antwerp, Belgium
- Antwerp University (UA), Campus Drie Eiken Universiteitsplein 1, 2610, Antwerp, Belgium
- University Forensic Centre, University Hospital Antwerp (UZA), Campus Drie Eiken Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Meike Van Nuffel
- UPC St Camillus Bierbeek, Krijkelberg 1, 3360, Bierbeek, Belgium
| | - Kris Goethals
- Collaborative Antwerp Psychiatric Research institute (CAPRI), Campus Drie Eiken Universiteitsplein 1, 2610, Antwerp, Belgium
- Antwerp University (UA), Campus Drie Eiken Universiteitsplein 1, 2610, Antwerp, Belgium
- University Forensic Centre, University Hospital Antwerp (UZA), Campus Drie Eiken Universiteitsplein 1, 2610, Antwerp, Belgium
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21
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Lamberti JS. Preventing Criminal Recidivism Through Mental Health and Criminal Justice Collaboration. Psychiatr Serv 2016; 67:1206-1212. [PMID: 27417893 PMCID: PMC7280932 DOI: 10.1176/appi.ps.201500384] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Criminal justice system involvement is common among persons with serious mental illness in community treatment settings. Various intervention strategies are used to prevent criminal recidivism among justice-involved individuals, including mental health courts, specialty probation, and conditional release programs. Despite differences in these approaches, most involve the use of legal leverage to promote treatment adherence. Evidence supporting the effectiveness of leverage-based interventions at preventing criminal recidivism is mixed, however, with some studies suggesting that involving criminal justice authorities in mental health treatment can increase recidivism rates. The effectiveness of interventions that utilize legal leverage is likely to depend on several factors, including the ability of mental health and criminal justice staff to work together. Collaboration is widely acknowledged as essential in managing justice-involved individuals, yet fundamental differences in goals, values, and methods exist between mental health and criminal justice professionals. This article presents a six-step conceptual framework for optimal mental health-criminal justice collaboration to prevent criminal recidivism among individuals with serious mental illness who are under criminal justice supervision in the community. Combining best practices from each field, the stepwise process includes engagement, assessment, planning and treatment, monitoring, problem solving, and transition. Rationale and opportunities for collaboration at each step are discussed.
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Affiliation(s)
- J Steven Lamberti
- Dr. Lamberti is with the Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (e-mail: )
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22
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Kriegel LS, Henwood BF, Gilmer TP. Implementation and Outcomes of Forensic Housing First Programs. Community Ment Health J 2016; 52:46-55. [PMID: 26438288 DOI: 10.1007/s10597-015-9946-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Abstract
This mixed-method study used administrative data from 68 supportive housing programs and evaluative and qualitative site visit data from a subset of four forensic programs to (a) compare fidelity to the Housing First model and residential client outcomes between forensic and nonforensic programs and (b) investigate whether and how providers working in forensic programs can navigate competing Housing First principles and criminal justice mandates. Quantitative findings suggested that forensic programs were less likely to follow a harm reduction approach to substance use and clients in those programs were more likely to live in congregate settings. Qualitative findings suggested that an interplay of court involvement, limited resources, and risk environments influenced staff decisions regarding housing and treatment. Existing mental health and criminal justice collaborations necessitate adaptation to the Housing First model to accommodate client needs.
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Affiliation(s)
- Liat S Kriegel
- School of Social Work, University of Southern California, Montgomery Ross Fisher Building, Los Angeles, CA, 90089-0411, USA.
| | - Benjamin F Henwood
- School of Social Work, University of Southern California, Montgomery Ross Fisher Building, Los Angeles, CA, 90089-0411, USA
| | - Todd P Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, 92093, USA
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Morse DS, Silverstein J, Thomas K, Bedel P, Cerulli C. Finding the loopholes: a cross-sectional qualitative study of systemic barriers to treatment access for women drug court participants. HEALTH & JUSTICE 2015; 3:12. [PMID: 26478853 PMCID: PMC4607061 DOI: 10.1186/s40352-015-0026-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Therapeutic diversion courts seek to address justice-involved participants' underlying problems leading to their legal system involvement, including substance use disorder, psychiatric illness, and intimate partner violence. The courts have not addressed systemic hurdles, which can contribute to a cycle of substance use disorder and recidivism, which in turn hinder health and wellness. The study purpose is to explore the systemic issues faced by women participants in drug treatment court from multiple perspectives to understand how these issues may relate to health and wellness in their lives. METHODS Qualitative thematic framework analysis of five separate focus groups consisting of female drug treatment court participants, community providers, and court staff (n = 25). Themes were mapped across the socio-ecological framework and contextualized according to social determinants of health. RESULTS Numerous systemic factors impacted women's access to treatment. Laws and legal policies (governance) excluded those who could potentially have benefitted from therapeutic court and did not allow consideration of parenting issues. Macroeconomic policies limit housing options for those with convictions. Social policies limited transportation, education, and employment options. Public policies limited healthcare and social protection and ability to access available resources. Culture and societal values, including stigma, limited treatment options. CONCLUSIONS By understanding the social determinant of health for women in drug treatment court and stakeholder's perceptions, the legal system can implement public policy to better address the health needs of women drug court participants.
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Affiliation(s)
- Diane S. Morse
- University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd., Rochester, NY 14642 USA
- University of Rochester School of Medicine, Women’s Initiative Supporting Health Center for Community Health, 300 Crittenden Blvd., Rochester, NY 14642 USA
| | - Jennifer Silverstein
- University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd., Rochester, NY 14642 USA
| | - Katherine Thomas
- University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd., Rochester, NY 14642 USA
| | - Precious Bedel
- University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd., Rochester, NY 14642 USA
| | - Catherine Cerulli
- University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd., Rochester, NY 14642 USA
- University of Rochester School of Medicine, LIVV and Susan B. Anthony Center for Women’s Leadership, 300 Crittenden Blvd., Rochester, NY 14642 USA
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Stuen HK, Rugkåsa J, Landheim A, Wynn R. Increased influence and collaboration: a qualitative study of patients' experiences of community treatment orders within an assertive community treatment setting. BMC Health Serv Res 2015; 15:409. [PMID: 26400028 PMCID: PMC4581043 DOI: 10.1186/s12913-015-1083-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 09/21/2015] [Indexed: 11/24/2022] Open
Abstract
Background Since 2009, 14 assertive community treatment (ACT) teams have started up in Norway. Over 30 % of the patients treated by the ACT teams were subject to community treatment orders (CTOs) at intake. CTOs are legal mechanisms to secure treatment adherence for patients with severe mental illness. Little is known about patients’ views and experiences of CTOs within an ACT context. Methods The study was based on qualitative in depth interviews with 15 patients that were followed up by ACT teams and that were currently subjected to CTOs. The data were analyzed by using a modified grounded theory approach. Results While some participants experienced the CTO as a security net and as an important factor for staying well, others described the CTO as a social control mechanism and as a violation of their autonomy. Although experiencing difficulties and tensions, many participants described the ACT team as a different mental health arena from what they had known before, with another frame of interaction. Despite being legally compelled to receive treatment, many participants talked about how the ACT teams focused on addressing unmet needs, the management of future crises, and finding solutions to daily life problems. Assistance with housing and finances, reduced social isolation, and being able to seek help voluntarily were positive outcomes emphasized by many patients. Discussion The participants had different views of being on a CTO within an ACT setting. While some remained clearly negative to the CTO, others described a gradual transition toward regarding the CTO as an acceptablesolution as they gained experience of ACT. Many of the participants valued the supportive relationship withthe ACT team, and communication with the care providers and the care providers’ attitudes could make a significant difference. The study shows that the perception of coercion is context dependent, and that the relationship between care providers and patients is of importance to how patients interpret the providers’ behavior and the restrictive interventions. Conclusions Although some patients focused on loss of autonomy and being compelled to take medications, other patients emphasised the supportive relationships they had with the ACT teams and that they had received help with housing, finances, and other daily life problems. Thus, being on mandated community treatment could be acceptable in the opinion of several of the patients, provided that they received other services that they found beneficial.
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Affiliation(s)
- Hanne Kilen Stuen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brummundal, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway. .,Departement of Psychiatry, University of Oxford, Oxford, UK.
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brummundal, Norway. .,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
| | - Rolf Wynn
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway. .,Divison of Mental Health and Addictions, University Hospital of North Norway, Tromsø, Norway.
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