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Evans M, Cuddeback GS, Golin C, Muessig K, Bellamy C, Costa M, O'Connell M, Fisher EB. Diverse elements comprising studies of peer support complicate evidence synthesis. J Ment Health 2024:1-15. [PMID: 38556804 DOI: 10.1080/09638237.2024.2332798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 01/20/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Innovative approaches to care, such as peer support, are needed to address the substantial and frequently unmet needs of people with serious mental illnesses such as schizophrenia. Although peer support services continue to expand in mental healthcare, findings of effectiveness from systematic reviews are mixed. However, the studies evaluated in these reviews consisted of diverse elements which the review methods neglected to consider. AIMS This review aims to demonstrate the substantial diversity in intervention components and measured outcomes among studies of peer support and lay the groundwork for more focused reviews of individual intervention components. METHODS As part of a realist review of the literature, here we synthesize evidence in a way that examines the substantial diversity in intervention components and measured outcomes comprising studies of peer support. RESULTS Seven categories of outcomes were represented, including recovery, symptoms and functioning, and care utilization. Importantly, seven distinct intervention components were represented in 26 studies: "being there," assistance in self-management, linkage to clinical care and community resources, social and emotional support, ongoing support, explicit utilization of shared lived experience or peer support values, and systems advocacy. Reflecting diversity in approaches, no study reported all intervention components, and no component was found among all studies. IMPLICATIONS Peer support services constitute a category of intervention approaches far too varied to evaluate as a single entity. Results suggest intervention components deserving more focused research, including assistance in self-management, "being there," and explicit utilization of shared lived experience or peer support values. PRISMA/PROSPERO As this article reports results from a realist review of the literature, we did not follow the PRISMA guidance which is suitable for systematic reviews. We did follow the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines.This review was not registered on PROSPERO as it is not a systematic review.
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Affiliation(s)
- Megan Evans
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Gary S Cuddeback
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Carol Golin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kathryn Muessig
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Chyrell Bellamy
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Mark Costa
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Maria O'Connell
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Edwin B Fisher
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Cuddeback GS, Van Deinse TB, DiRosa E, Murray-Lichtman A, Givens A, Mercer MC. Implementing evidence-based supported employment within specialty mental health probation: A hybrid type I implementation-effectiveness trial protocol. Contemp Clin Trials 2023; 134:107342. [PMID: 37730200 DOI: 10.1016/j.cct.2023.107342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/02/2023] [Accepted: 09/16/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND People with serious mental illnesses who are involved in the criminal justice system face significant challenges in obtaining meaningful employment. Given the importance of employment in reducing recidivism, the field needs effective interventions to increase employment rates, address mental health needs, and reduce recidivism for justice-involved people with serious mental illnesses. Individual Placement and Support - Supported Employment (IPS-SE) improves employment outcomes among individuals with serious mental illnesses and has shown promising results when implemented with individuals with histories of justice involvement; however, IPS-SE has only been implemented in mental health service settings. Given lower levels of treatment engagement and completion among justice-involved populations, implementation of IPS-SE in specialty mental health probation (SMHP) is an opportunity to increase reach and engagement among justice-involved people with serious mental illnesses. METHODS This article describes a hybrid type 1 implementation-effectiveness study that aims to: (1) assess the implementation enablers and barriers, as well as the feasibility, appropriateness, and acceptability of IPS-SE embedded within SMHP; (2) identify the multi-level factors (i.e., implementation determinants) that influence IPS-SE implementation within the context of a probation setting; and (3) assess the impact of IPS-SE on employment - our primary endpoint - and the impact of IPS-SE on a number of secondary outcomes and potential treatment mechanisms. The efficacy arm of the study will be a randomized controlled trial of 130 adults on community supervision who will either receive treatment as usual or IPS-SE. The implementation arm of the study will examine implementation determinants and implementation outcomes using qualitative methods.
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Affiliation(s)
- Gary S Cuddeback
- Virginia Commonwealth University in the School of Social Work, United States of America.
| | - Tonya B Van Deinse
- University of North Carolina at Chapel Hill School of Social Work, United States of America.
| | - Elena DiRosa
- School of Medicine at the University of North Carolina at Chapel Hill, United States of America.
| | - Andrea Murray-Lichtman
- University of North Carolina at Chapel Hill School of Social Work, United States of America.
| | - Ashley Givens
- School of Social Work at the University of Missouri-Columbia, United States of America.
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Van Deinse TB, Mercier MC, Waters AK, Disbennett M, Cuddeback GS, Velázquez T, Lichtman AM, Taxman F. Strategies for supervising people with mental illnesses on probation caseloads: results from a nationwide study. Health Justice 2023; 11:41. [PMID: 37824043 PMCID: PMC10570184 DOI: 10.1186/s40352-023-00241-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
Probation officers are tasked with supervising the largest number of people living with mental illnesses in the criminal legal system, with an estimated 16-27% of individuals on probation identified as having a mental health condition. While academic research has recently focused on building the evidence base around the prototypical model of specialty mental health probation, less focus has been directed to the individual components of specialized mental health caseloads and other strategies agencies use to supervise people with mental illnesses. More specific information about these strategies would benefit probation agencies looking to implement or enhance supervision protocols for people with mental illnesses. This article describes the results from a nationwide study examining (1) probation agencies' mental health screening and identification methods; (2) characteristics of mental health caseloads, including eligibility criteria, officer selection, required training, and interfacing with service providers; and (3) other strategies agencies use to supervise people with mental illnesses beyond mental health caseloads. Strategies for identifying mental illnesses varied, with most agencies using risk needs assessments, self-report items asked during the intake process, or information from pre-sentencing reports. Less than a third of respondents reported using screening and assessment tools specific to mental health or having a system that tracks or "flags" mental illnesses. Results also showed wide variation in mental health training requirements for probation officers, as well as variation in the strategies used for supervising people with mental illnesses (e.g., mental health caseloads, embedded mental health services within probation, modified cognitive behavioral interventions). The wide variation in implementation of supervision strategies presents (1) an opportunity for agencies to select from a variety of strategies and tailor them to fit the needs of their local context and (2) a challenge in building the evidence base for a single strategy or set of strategies.
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Affiliation(s)
- Tonya B Van Deinse
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA.
| | - Mariah Cowell Mercier
- Utah Criminal Justice Center, University of Utah, 395 S 1500 E, Salt Lake City, UT, 84112, USA
| | - Allison K Waters
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA
| | - Mackensie Disbennett
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA
| | - Gary S Cuddeback
- School of Social Work, Virginia Commonwealth University, Academic Learning Commons, 3rd Floor, 1000 Floyd Avenue, P.O. Box 842027, Richmond, VA, 23284, USA
| | - Tracy Velázquez
- Safety & Justice Research, The Pew Charitable Trusts, 2005 Market Street, Suite 1700, Philadelphia, PA, 19103, USA
| | - Andrea Murray Lichtman
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA
| | - Faye Taxman
- Schar School of Policy and Government, George Mason University, 3351 Fairfax Drive Van Metre Hall, Arlington, VA, 22201, USA
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Danielson EC, Smith MJ, Ross B, Parham B, Johnson JE, Cuddeback GS, Smith JD, McGregor D, Suganuma A, Jordan N. Implementation Preparation Costs of Virtual Reality Job Interview Training in Prisons: A Budget Impact Analysis. J Offender Rehabil 2023; 62:81-97. [PMID: 38529012 PMCID: PMC10961941 DOI: 10.1080/10509674.2022.2160040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Virtual Reality Job Interview Training (VR-JIT) has increased employment rates for returning citizens when added to a successful prison-based employment readiness program. However, implementation preparation cost-expenses prior to offering VR-JIT to intended recipients-is unknown. We estimated the cost of implementation preparation activities (e.g., organizing workflow) for two prisons to deliver VR-JIT. We conducted a budget impact analysis and enumerated the labor costs incurred during this important stage of implementation. Labor costs were approximately $8,847 per prison. Our sensitivity analysis estimated the labor costs to replicate this effort in a new prison to range from $2,877 to $4,306 per prison. Thus, VR-JIT may be an affordable tool for prison-based employment readiness programs to improve gainful employment.
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Affiliation(s)
- Elizabeth C. Danielson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Brittany Ross
- School of Social Work, University of Michigan, Ann Arbor, MI
| | - Brittani Parham
- School of Social Work, University of Michigan, Ann Arbor, MI
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Jennifer E. Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI
| | - Gary S. Cuddeback
- School of Social Work, Virginia Commonwealth University, Richmond, VA
| | - Justin D. Smith
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | | | | | - Neil Jordan
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL
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Givens A, Cuddeback GS. Traumatic experiences among individuals with severe mental illnesses on probation. Crim Behav Ment Health 2021; 31:310-320. [PMID: 34498309 DOI: 10.1002/cbm.2212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The large and growing number of individuals with severe mental illnesses who are on probation presents challenges to both mental health and criminal justice authorities. The clinical and mental health service needs of probationers with severe mental illnesses have however, been insufficiently researched, particularly with respect to trauma and the need for trauma-informed services. AIMS To explore the lifetime prevalence of post-traumatic stress disorder (PTSD) among people on probation who also have other serious mental illnesses and their demographic characteristics. METHODS Individuals on probation in six counties in one southeastern state who had been diagnosed with severe mental illnesses were assessed for PTSD; they were also asked whether they had experienced any of 14 traumatic events of interest over their lifetimes. RESULTS Of 207 participants, about half had clinically diagnosable PTSD. Nearly two-thirds had experienced more than five traumatic events during their lifetimes: 86% experienced at least one non-interpersonal traumatic event, such as a car accident, and 90% experienced at least one interpersonal traumatic event, such as a physical assault. The latter was the single most frequently reported traumatic event (80%, n = 160). PTSD was, on average, associated with a higher number of prior traumatic experiences overall. CONCLUSIONS In one state in the USA, rates of trauma experiences and PTSD among probationers with other mental illnesses are high. Relative to prisoners, little is known about the mental health needs among probationers, so replication in a larger sample across jurisdictions would be useful. Findings are likely to have implications for form of service delivery as well as treatment needs.
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Affiliation(s)
| | - Gary S Cuddeback
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Givens AD, Blank Wilson A, Van Deinse TB, Murray-Lichtman A, Cuddeback GS. Physical Health Problems Among People With Severe Mental Illnesses: Race, Gender, and Implications for Practice. J Am Psychiatr Nurses Assoc 2021; 27:283-291. [PMID: 34053320 PMCID: PMC9305630 DOI: 10.1177/10783903211014943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Individuals with severe mental illnesses experience high rates of chronic health conditions; however, the extent to which risk of chronic physical health problems varies by race and gender among these individuals is understudied. AIMS: This study examines variations in health problems by race and gender among individuals with severe mental illnesses. METHOD: Administrative data, which included blood pressure, body mass index (BMI), and glycated hemoglobin (HbA1c) values, were obtained from 603 individuals with serious mental illnesses who received integrated health and behavioral health services from a large mental health agency in the Midwest. Bivariate and multivariate statistical models were used to examine variation in physical health problems by race and gender. RESULTS: Compared with men, women with severe mental illnesses were more likely to have BMI levels indicating obesity or morbid obesity (p < .001). Compared with White participants, Black participants were less likely to have high HbA1c levels (p < .001) but were more likely to have high blood pressure (p < .001). Among race and gender groups, Black women were more likely to have high BMI (p < .05), Black men were more likely to have high blood pressure (p < .001), and White men were more likely to have high HbA1c levels (p < .01) when holding constant all other variables. CONCLUSIONS: There is evidence that types and severity of physical health problems among individuals with severe mental illnesses varies by race and gender. Replication of these results and more research is needed to ensure that health-related education and integrated health and behavioral health interventions meet the needs of individuals with serious mental illnesses.
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Affiliation(s)
- Ashley D Givens
- Ashley D. Givens, PhD, MSW, University of Missouri-Columbia, Columbia, MO, USA
| | - Amy Blank Wilson
- Amy Blank Wilson, PhD, LSW, University of North Carolina at Chapel Hill, NC, USA
| | - Tonya B Van Deinse
- Tonya B. Van Deinse, PhD, MSW, University of North Carolina at Chapel Hill, NC, USA
| | | | - Gary S Cuddeback
- Gary S. Cuddeback, PhD, MSW, MPH, University of North Carolina at Chapel Hill, NC, USA
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Soda T, Richards J, Gaynes BN, Cueva M, Laux J, McClain C, Frische R, Lindquist LK, Cuddeback GS, Jarskog LF. Systematic Quality Improvement and Metabolic Monitoring for Individuals Taking Antipsychotic Drugs. Psychiatr Serv 2021; 72:647-653. [PMID: 33887956 PMCID: PMC8192348 DOI: 10.1176/appi.ps.202000155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to increase the rate of cardiometabolic monitoring for patients receiving antipsychotic drugs in an academic outpatient psychiatric clinic serving people with serious mental illness. METHODS Using a prospective quasi-experimental, interrupted time-series design with data from the electronic health record (EHR), the authors determined metabolic monitoring rates before, during, and after implementation of prespecified quality improvement (QI) measures between August 2016 and July 2017. QI measures included a combination of provider, patient, and staff education; systematic barrier reduction; and an EHR-based reminder system. RESULTS After 1 year of QI implementation, the rate of metabolic monitoring had increased from 33% to 49% (p<0.01) for the primary outcome measure (hemoglobin A1C and lipid panel). This increased monitoring rate was sustained for 27 months beyond the end of the QI intervention. More than 75% of providers did not find the QI reminders burdensome. CONCLUSIONS Significant improvement in the rate of metabolic monitoring for people taking antipsychotic drugs can be achieved with little added burden on providers. Future research needs to assess the full range of patient, provider, and system barriers that prevent cardiometabolic monitoring for all individuals receiving antipsychotic drugs.
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Affiliation(s)
- Takahiro Soda
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Jennifer Richards
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Bradley N Gaynes
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Michelle Cueva
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Jeffrey Laux
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Christine McClain
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Rachel Frische
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Lisa K Lindquist
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - Gary S Cuddeback
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
| | - L Fredrik Jarskog
- Department of Psychiatry (Soda, Gaynes, Cueva, Frische, Cuddeback, Jarskog), North Carolina Translational and Clinical Sciences Institute (Laux), and School of Social Work (Cuddeback), University of North Carolina at Chapel Hill, Chapel Hill; Cherry Hospital, North Carolina Department of Health and Human Services, Goldsboro (Richards); Northwest Human Services, Salem, Inc., Salem, Oregon (McClain); Department of Psychiatry, Providence Alaska Medical Center, Anchorage (Lindquist)
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Van Deinse TB, Cuddeback GS, Wilson AB, Edwards D, Lambert M. Variation in Criminogenic Risks by Mental Health Symptom Severity: Implications for Mental Health Services and Research. Psychiatr Q 2021; 92:73-84. [PMID: 32458340 PMCID: PMC7957914 DOI: 10.1007/s11126-020-09782-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although a growing body of literature has demonstrated that justice-involved people with mental illnesses have criminogenic risk factors at similar or elevated rates as compared to justice-involved people without mental illnesses, more information about how criminogenic risks vary by intensity of mental health symptoms is needed. This information is particularly important for probation agencies who supervise the vast majority of justice-involved individuals with mental illnesses and who are increasingly implementing specialty mental health supervision approaches. To this end, this study examines the relationship between criminogenic risk and intensity of self-reported symptoms of mental illnesses among 201,905 individuals on probation from a large southeastern state. Self-report measures of symptoms of mental illnesses were categorized as low, moderate or high and criminogenic risks were compared among the following three groups: (1) those with no or low self-reported symptoms of mental illness; (2) those reporting moderate levels of symptoms; and (3) those reporting high or elevated levels of symptoms. Our findings suggest that the strength of relationships between symptoms of mental illnesses and criminogenic risks varies by type of criminogenic risk. Also, elevated symptoms of mental illness are associated with higher levels of criminogenic risks. More research about interventions that address mental illnesses and criminogenic risks is needed to inform practice and policy.
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Affiliation(s)
- Tonya B Van Deinse
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA.
| | - Gary S Cuddeback
- School of Social Work, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA
| | - Amy Blank Wilson
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA
| | - Daniel Edwards
- Research, Planning, & Process Improvement, Missouri Department of Corrections, 2729 Plaza Dr., Jefferson City, MO, 65109, USA
| | - Michael Lambert
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA
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Longmate C, Lowder E, Givens A, Van Deinse TB, Ghezzi M, Burgin S, Cuddeback GS. Social support among people with mental illnesses on probation. Psychiatr Rehabil J 2021; 44:70-76. [PMID: 32584072 DOI: 10.1037/prj0000428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Justice-involved people with mental illnesses, in general, experience poor criminal justice outcomes (i.e., high rates of recidivism and probation revocations) and are at increased risk of homelessness, unemployment, stigma, trauma, and poor physical health. Low social support is repeatedly associated with worse mental health outcomes in the general population but little is known about social support among probationers with serious mental illnesses. METHOD To address these gaps in the literature, we used an observational cross-sectional study design and data from a large, randomized controlled trial of specialty mental health probation to examine self-reported social support and its relationships with mental health functioning and other outcomes for individuals with serious mental illnesses on supervised probation. RESULTS Probationers who self-reported lower levels of social support also reported greater mental health symptomatology and reported lower quality relationships with their probation officers. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Low social support among probationers with mental illnesses has important implications for mental health and criminal justice practice and policy. Coordinating services between the criminal justice and mental health systems to offer opportunities for social support and meaningful community engagement for those with mental illnesses who are on probation could improve a number of mental health and criminal justice outcomes for this population. Peer support and supported employment services, for example, in addition to outpatient mental health services, could be two strategies that could address social isolation and help individuals living with mental illnesses optimize their recovery and rehabilitation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Bremmers LGM, Evers SMAA, Drost RMWA, Janssen LMM, Pokhilenko I, Paulus ATG, Norton EC, Yoon J, Cuddeback GS, Morrissey JP. Intersectoral Costs and Benefits of Mental and Behavioural Disorders in the Education Sector: an Exploration of Costing Methods. J Ment Health Policy Econ 2020; 23:115-137. [PMID: 33411675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/06/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The inclusion of indirect spillover costs and benefits that occur in non-healthcare sectors of society is necessary to make optimal societal decisions when assessing the cost effectiveness of healthcare interventions. Education costs and benefits are relevant in the disease area of mental and behavioral disorders, but their inclusion in economic evaluations is largely neglected due to lack of methodological knowledge. AIM OF THE STUDY This study aims to explore, using a scoping review, the identification, measurement, and valuation methods used to assess the impact of mental and behavioural disorders on education costs and benefits. METHODS A scoping review was conducted to identify articles that were set in the education sector and assessed education costs and benefits. An adapted 5-step approach was used: (i) initating a scoping review; (ii) identifying component studies; (iii) data extraction; (iv) reporting results; (v) discussion and interpretation of findings. Results were summarized in a narrative synthesis per identification, measurement, and valuation method. RESULTS 177 component articles were identified in the scoping review that reported 61 mutually exclusive education costs and benefits. The nomenclature used to describe the costs and benefits was poorly defined, heterogeneous in nature and largely context dependent. This was also reflected in the diverse number of measurement and valuation methods found in the component articles. DISCUSSION This is the first study, which offers a classification of education costs and benefits and costing methods reported by studies set in the education sector. In conclusion, mental and behavioral disorders have a notable impact on a variety of different education costs and benefits. IMPLICATIONS FOR HEALTH POLICIES The classification provided in the current study gives an indication of the wide-spread impact of mental and behavioral disorders on the education sector. Hence, the inclusion of relevant education costs and benefits in economic evaluations for mental and behavioral disorders is necessary to make optimal societal decisions. IMPLICATIONS FOR FURTHER RESEARCH By exploring a new area of research from a sector-specific perspective, the current study adds to the existing intersectoral cost and benefit literature base. Future research should focus on standardizing costing methods in pharmacoeconomic guidelines and assessing the relative importance of individual education costs and benefits in economic evaluations for specific interventions and diseases.
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Affiliation(s)
- Leonarda G M Bremmers
- Erasmus School of Health Policy and Management, Bayle (J) Building, Room J8-55, Burgemeester Oudlaan 50, 3062 PA Rotterdam, NL,
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11
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Domino ME, Norton EC, Yoon J, Cuddeback GS, Morrissey JP. Putting Providers At-Risk through Capitation or Shared Savings: How Strong are Incentives for Upcoding and Treatment Changes? J Ment Health Policy Econ 2020; 23:81-91. [PMID: 32853157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Alternative payment models, including Accountable Care Organizations and fully capitated models, change incentives for treatment over fee-for-service models and are widely used in a variety of settings. The level of payment may affect the assignment to a payment category, but to date the upcoding literature has been motivated largely incorporating financial penalties for upcoding rather than by a theoretical model that incorporates the downstream effects of upcoding on service provision requirements. AIMS OF THE STUDY In this paper, we contribute to the literature on upcoding by developing a new theoretical model that is applicable to capitated, case-rate and shared savings payment systems. This model incorporates the downstream effects of upcoding on service provision requirements rather than just the avoidance of penalties. This difference is important especially for shared-savings models with quality benchmarks. METHODS We test implications of our theoretical model on changes in severity determination and service use associated with changes in case-rate payments in a publicly-funded mental health care system. We model provider-assigned severity categories as a function of risk-adjusted capitated payments using conditional logit regressions and counts of service days per month using negative binomial models. RESULTS We find that severity determination is only weakly associated with the payment rate, with relatively small upcoding effects, but that level of use shows a greater degree of association. DISCUSSION These results are consistent with our theoretical predictions where the marginal utility of savings or profit is small, as would be expected from public sector agencies. Upcoding did seem to occur, but at very small levels and may have been mitigated after the county and providers had some experience with the new system. The association between the payment levels and the number of service days in a month, however, was significant in the first period, and potentially at a clinically important level. Limitations include data from a single county/multiple provider system and potential unmeasured confounding during the post-implementation period. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE Providers in our data were not at risk for inpatient services but decreases in use of outpatient services associated with rate decreases may lead to further increases in inpatient use and therefore expenditures over time. IMPLICATIONS FOR HEALTH POLICIES Health program directors and policy makers need to be acutely aware of the interplay between provider payments and patient care and eventual health and mental health outcomes. IMPLICATIONS FOR FURTHER RESEARCH Further research could examine the implications of the theoretical model of upcoding in other payment systems, estimate the power of the tiered-risk systems, and examine their influence on clinical outcomes.
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Affiliation(s)
- Marisa Elena Domino
- Department of Health Policy and Management and Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC 27599-7411, USA,
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12
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Smith MJ, Mitchell JA, Blajeski S, Parham B, Harrington MM, Ross B, Sinco B, Brydon DM, Johnson JE, Cuddeback GS, Smith JD, Jordan N, Bell MD, McGeorge R, Kaminski K, Suganuma A, Kubiak SP. Enhancing vocational training in corrections: A type 1 hybrid randomized controlled trial protocol for evaluating virtual reality job interview training among returning citizens preparing for community re-entry. Contemp Clin Trials Commun 2020; 19:100604. [PMID: 32671283 PMCID: PMC7339026 DOI: 10.1016/j.conctc.2020.100604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/17/2020] [Accepted: 06/28/2020] [Indexed: 11/18/2022] Open
Abstract
The Michigan Department of Corrections operates the Vocational Villages, which are skilled trades training programs set within prisons that include an immersive educational community using virtual reality, robotics, and other technologies to develop employable trades. An enhancement to the Vocational Villages could be an evidence-based job interview training component. Recently, we conducted a series of randomized controlled trials funded by the National Institute of Mental Health to evaluate the efficacy of virtual reality job interview training (VR-JIT). The results suggested that the use of VR-JIT was associated with improved job interview skills and a greater likelihood of receiving job offers within 6 months. The primary goal of this study is to report on the protocol we developed to evaluate the effectiveness of VR-JIT at improving interview skills, increasing job offers, and reducing recidivism when delivered within two Vocational Villages via a randomized controlled trial and process evaluation. Our aims are to: (1) evaluate whether services-as-usual in combination with VR-JIT, compared to services-as-usual alone, enhances employment outcomes and reduces recidivism among returning citizens enrolled in the Vocational Villages; (2) evaluate mechanisms of employment outcomes and explore mechanisms of recidivism; and (3) conduct a multilevel, mixed-method process evaluation of VR-JIT implementation to assess the adoptability, acceptability, scalability, feasibility, and implementation costs of VR-JIT.
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Affiliation(s)
- Matthew J. Smith
- University of Michigan School of Social Work, Ann Arbor, MI, USA
- Corresponding author. School of Social Work, University of Michigan, 1080 South University Avenue, Room 3796, Ann Arbor, MI, 48109-1106.
| | | | - Shannon Blajeski
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Brittani Parham
- University of Michigan School of Social Work, Ann Arbor, MI, USA
- University of Michigan Department of Psychology, Ann Arbor, MI, USA
| | | | - Brittany Ross
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Brandy Sinco
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Daphne M. Brydon
- University of Michigan School of Social Work, Ann Arbor, MI, USA
- University of Denver Graduate School of Social Work, Denver, CO, USA
| | | | - Gary S. Cuddeback
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC, USA
| | - Justin D. Smith
- Northwestern University Feinberg School of Medicine Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
| | - Neil Jordan
- Northwestern University Feinberg School of Medicine Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
- Hines VA Center of Innovation for Complex Chronic Healthcare, USA
| | - Morris D. Bell
- Yale School of Medicine, Department of Psychiatry, West Haven, CT, USA
| | | | - Kyle Kaminski
- Michigan Department of Corrections, Lansing, MI, USA
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Van Deinse TB, Bunger A, Burgin S, Wilson AB, Cuddeback GS. Using the Consolidated Framework for Implementation Research to examine implementation determinants of specialty mental health probation. Health Justice 2019; 7:17. [PMID: 31807941 PMCID: PMC6896670 DOI: 10.1186/s40352-019-0098-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Specialty mental health probation (SMHP) is designed to improve outcomes for the large number of people with serious mental illnesses who are on probation and/or parole. The evidence for specialty mental health probation is promising; however, little is known about the implementation challenges and facilitators associated with SMHP. To address this gap, we used the consolidated framework for implementation research (CFIR) to analyze 26 interviews with stakeholders representing multiple agencies involved in the implementation of SMHP. RESULTS Results indicate a number of challenges and facilitators related to the inner setting, outer setting, implementation process, and characteristics of individuals. CONCLUSIONS Findings suggest that complex and cross-sectoral interventions are context-dependent and introduce a number of challenges and facilitators related to multiple CFIR domains. Consequently, agency administrators implementing these types of interventions should consider small pilot studies and develop implementation strategies tailored to the local implementation context.
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Affiliation(s)
- Tonya B. Van Deinse
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC 27599 USA
| | - Alicia Bunger
- College of Social Work, The Ohio State University, 1947 N. College Rd., Columbus, OH 43210 USA
| | - Stacey Burgin
- Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Dr #1, Chapel Hill, NC 27514 USA
| | - Amy Blank Wilson
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC 27599 USA
| | - Gary S. Cuddeback
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC 27599 USA
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15
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Cuddeback GS. Jails and Prisons: Caring for Those With Complex Needs. N C Med J 2019; 80:357-358. [PMID: 31685572 DOI: 10.18043/ncm.80.6.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Gary S Cuddeback
- professor, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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16
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Hunt MG, Cuddeback GS, Bromley E, Bradford DW, Hoff RA. Changing Rates of Mental Health Disorders Among Veterans Treated in the VHA During Troop Drawdown, 2007-2013. Community Ment Health J 2019; 55:1120-1124. [PMID: 31292835 DOI: 10.1007/s10597-019-00437-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/25/2019] [Indexed: 11/25/2022]
Abstract
Nationally representative data on mental health disorder prevalence are critical to set informed mental health priorities and policies. Data indicating mental health diagnoses within our nation's veteran population treated at the Veterans Health Administration (VHA) are available, but have yet to be examined for changing trends to inform both VHA and community care. We use VHA national program evaluation data from a time of increasing military enrollment (2007) to troop draw down (2013) to examine changes over time in the number of diagnoses in veterans receiving VHA services. The number of veterans in all diagnostic categories increased during our study period with the smallest increase in psychotic disorders (8%) and the largest in posttraumatic stress disorder (71%). Trends in behavioral health diagnoses among veterans have important implications for policy and clinician competencies within VHA and community providers as veteran mental health care needs change.
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Affiliation(s)
- Marcia G Hunt
- VISN1 Mental Illness Research Education and Clinical Center (MIRECC), New England Healthcare System, 950 Campbell Avenue, West Haven, CT, 06511, USA. .,Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Gary S Cuddeback
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27590, USA
| | - Elizabeth Bromley
- Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), West Los Angeles VA Healthcare Center, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, Center for Health Services and Society, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA, 90024, USA
| | - Daniel W Bradford
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Durham VA Medical Center, Durham, NC, USA
| | - Rani A Hoff
- VISN1 Mental Illness Research Education and Clinical Center (MIRECC), New England Healthcare System, 950 Campbell Avenue, West Haven, CT, 06511, USA.,Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
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17
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Cuddeback GS, Grady M, Blank Wilson A, Van Deinse T, Morrissey JP. Persons With Severe Mental Illnesses and Sex Offenses: Recidivism After Prison Release. Int J Offender Ther Comp Criminol 2019; 63:2157-2170. [PMID: 31014153 DOI: 10.1177/0306624x19842994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Individuals who have committed sex offenses (ISOs) with severe mental illnesses are a complex population to serve and more research is needed to guide practice and policy, especially around community supervision, enrollment in Medicaid, housing, employment, criminal justice contacts, and reincarceration after prison reentry. To further the literature in this area, we used logistic regression to model recidivism and admissions to violator or prison facilities among 127 ISOs with severe mental illnesses and 2,935 people with severe mental illnesses who were incarcerated in prison for other crimes. Compared to prison releasees with severe mental illnesses who committed crimes other than sex offenses, prison releasees with severe mental illnesses who committed sex offenses were admitted to violator facilities at higher rates, when controlling for substance use, Medicaid enrollment, homelessness, and unemployment. Implications for practice, policy and research are discussed.
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Affiliation(s)
| | - Melissa Grady
- 2 The Catholic University of America, Washington, DC, USA
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18
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Scanlon F, Schatz D, Scheidell JD, Cuddeback GS, Frueh BC, Khan MR. National Study of Childhood Traumatic Events and Adolescent and Adult Criminal Justice Involvement Risk: Evaluating the Protective Role of Social Support From Mentors During Adolescence. J Clin Psychiatry 2019; 80:18m12347. [PMID: 31433588 PMCID: PMC6820137 DOI: 10.4088/jcp.18m12347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE With nearly 11 million people in the United States arrested in 2015, the need to identify antecedent risk factors driving criminal justice involvement (CJI) and possible mitigating factors is crucial. This study examines the relation between childhood trauma and CJI in adolescence and adulthood and assesses how this relation is moderated by mentoring during young adulthood. METHODS The analysis included 3 waves of data-adolescents, young adults, and adults-collected from 1995 to 2008 from 12,288 adolescents who participated in the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adolescents in grades 7 to 12. Logistic regression was used to examine how having a close mentor in adolescence moderated the relation between criminal justice involvement and 9 childhood traumatic events: (1) neglect, (2) emotional abuse, (3) physical abuse, (4) sexual abuse, (5) parental incarceration, (6) parental binge drinking, (7) witnessed violence, (8) threatened with violence, and (9) experienced violence. RESULTS Cumulative exposure to childhood trauma was associated with CJI in adolescence (adjusted odds ratios [AORs] ranging from 2.24 to 25.98) and adulthood (AOR range, 1.82-6.69), and parental incarceration was consistently one of the, if not the, most strongly associated with each form of CJI; the strength of these associations was weakened for those who reported a close mentor compared to those who did not. CONCLUSIONS This study advances the literature regarding trauma and CJI, highlighting the role of social support and mentorship as protective factors for youth who experience childhood trauma. Interventions aimed at protecting vulnerable children from the harms of trauma should be the next priority.
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Affiliation(s)
- Faith Scanlon
- Texas Tech University, Psychological Sciences, Box 42051, Lubbock, TX 79409. .,Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
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19
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Domino ME, Gertner A, Grabert B, Cuddeback GS, Childers T, Morrissey JP. Do timely mental health services reduce re-incarceration among prison releasees with severe mental illness? Health Serv Res 2019; 54:592-602. [PMID: 30829406 DOI: 10.1111/1475-6773.13128] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To examine whether the receipt of timely mental health services is associated with changes in criminal justice interactions. DATA SOURCES We used linked administrative data from Medicaid, mental health, and criminal justice settings in Washington State for persons with severe mental illness released from prison (n = 3086). STUDY DESIGN We estimate local and average treatment effects to examine measures of criminal justice use in the year following release as a function of timely mental health services. DATA EXTRACTION METHODS Measures of timely service and criminal justice use within 12 months postrelease were created from administrative data. PRINCIPAL FINDINGS Individuals receiving timely mental health services are more likely to experience prison re-incarceration overall and specifically for technical violations 12 months postrelease. The effect of service receipt on incarceration for new charges was negative but not significant. CONCLUSIONS The finding that mental health services receipt is associated with increased risk of re-incarceration due to technical violations speaks to the complexity of the relationship between mental health and criminal justice services for justice-involved persons with severe mental illness. Further research should examine strategies at the interface of criminal justice and mental health that can improve mental health and criminal justice outcomes for this vulnerable population.
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Affiliation(s)
- Marisa Elena Domino
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alex Gertner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brigid Grabert
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gary S Cuddeback
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Trenita Childers
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph P Morrissey
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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20
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Gertner AK, Grabert B, Domino ME, Cuddeback GS, Morrissey JP. The effect of referral to expedited Medicaid on substance use treatment utilization among people with serious mental illness released from prison. J Subst Abuse Treat 2019; 99:9-15. [PMID: 30797401 DOI: 10.1016/j.jsat.2019.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 01/04/2023]
Abstract
Adults released from incarceration are at high risk of death from drug-related causes, pointing to the importance of connecting individuals to healthcare services after release from prison. Though Medicaid plays an important role in financing behavioral health treatments for vulnerable groups, many states terminate individuals' Medicaid coverage during incarceration. A significant risk factor for substance use disorders (SUD) among incarcerated individuals is serious mental illness (SMI). In January 2006, Washington State began a program of expedited Medicaid enrollment for individuals with mental illnesses being discharged from state prisons, jails, and psychiatric hospitals. Prior literature has shown this program to be effective in increasing Medicaid enrollment and use of mental health services for people with SMI. The current paper examined the effect of referral to expedited Medicaid on use of SUD treatment for people with SMI released from prison. Our sample consisted of 3086 individuals with a diagnosis of SMI who were released from prison from January 1, 2006 to December 31, 2007. Of the sample we identified, 871 individuals received referrals for expedited Medicaid and 2215 did not. To control for selection bias on observed characteristics for referral, we used inverse probability weights (IPW) to balance the referred and not-referred groups on more than 50 baseline covariates. We used doubly-robust IPW models to estimate the effect of referral to expedited Medicaid on use of SUD treatments following prison release. Approximately 12% of our sample used any SUD treatment by 3 months after release, with this percentage rising to 28% at 12 months. When controlling for baseline differences, referral to expedited Medicaid enrollment was associated on average with a 6.7 (SE 2.9, p < .05) percentage point increase in the predicted probability of using any SUD treatment in the 3 months following release as compared to those not referred to the program. This effect size represents a 61% increase in the probability of using any treatment by 3 months. The result was similar for the 6-month follow-up period and persisted at the 12-month follow-up though the magnitude of the effect decreased somewhat. Overall, our results suggest that expedited Medicaid enrollment for people with SMI released from prison can increase use of SUD services.
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Affiliation(s)
- Alex K Gertner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States of America.
| | - Brigid Grabert
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States of America
| | - Marisa Elena Domino
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States of America; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States of America
| | - Gary S Cuddeback
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States of America; School of Social Work, University of North Carolina at Chapel Hill, United States of America
| | - Joseph P Morrissey
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States of America; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States of America
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21
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Scanlon FA, Scheidell JD, Cuddeback GS, Samuelsohn D, Wohl DA, Lejuez CW, Latimer WW, Khan MR. Depression, Executive Dysfunction, and Prior Economic and Social Vulnerability Associations in Incarcerated African American Men. J Correct Health Care 2018; 24:295-308. [PMID: 29962264 PMCID: PMC6040589 DOI: 10.1177/1078345818782440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Low executive function (EF) and depression are each determinants of health. This study examined the synergy between deficits in EF (impaired cognitive flexibility; >75th percentile on the Wisconsin Card Sorting Test perseverative error score) and depressive symptoms (modified Centers for Epidemiologic Studies-Depression) and preincarceration well-being among incarcerated African American men ( N = 189). In adjusted analyses, having impaired EF and depression was strongly associated with pre-incarceration food insecurity (odds ratio [ OR] = 3.81, 95% confidence interval [CI] = [1.35, 10.77]), homelessness ( OR = 3.00, 95% CI [1.02, 8.80]), concern about bills ( OR = 3.76, 95% CI [1.42, 9.95]), low significant other support ( OR = 4.63, 95% CI [1.62, 13.24]), low friend support ( OR = 3.47, 95% CI [1.30, 9.26]), relationship difficulties ( OR = 2.86, 95% CI [1.05, 7.80]), and binge drinking ( OR = 3.62, 95% CI [1.22, 10.80]). Prison-based programs to treat depression and improve problem-solving may improve postrelease success.
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Affiliation(s)
- Faith A. Scanlon
- Division of Comparative Effectiveness and Decision Science,
Department of Population Health, NYU School of Medicine, 227 East 30th St,
New York, NY 10016 , (516)
361-1998
| | - Joy D. Scheidell
- Division of Comparative Effectiveness and Decision Science,
Department of Population Health, New York University School of Medicine, 227
East 30th St, New York, NY 10016
| | - Gary S. Cuddeback
- School of Social Work, University of North Carolina at Chapel Hill,
CB#3550, 325 Pittsboro Street, Chapel Hill, NC 27599
| | - Darcy Samuelsohn
- Division of Comparative Effectiveness and Decision Science,
Department of Population Health, NYU School of Medicine 227 East 30th St,
New York, NY 10016
| | - David A. Wohl
- Division of Infectious Disease, University of North Carolina at
Chapel Hill School of Medicine, CB# 7030, Bioinformatics Building,
130 Mason Farm Road, Chapel Hill, North Carolina 27599
| | - Carl W. Lejuez
- College of Liberal Arts & Sciences, University of Kansas,
Strong Hall, 1450 Jayhawk Boulevard, Lawrence, KS 66045
| | - William W. Latimer
- School of Health Sciences, Human Services, and Nursing, Lehman
College, 250 Bedford Park Blvd W, Bronx, NY 10468
| | - Maria R Khan
- Division of Comparative Effectiveness and Decision Science,
Department of Population Health, New York University School of Medicine, 227
East 30th St, New York, NY 10016
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Van Deinse TB, Wilson AB, Macy RJ, Cuddeback GS. Intimate Partner Violence and Women with Severe Mental Illnesses: Needs and Challenges from the Perspectives of Behavioral Health and Domestic Violence Service Providers. J Behav Health Serv Res 2018; 46:283-293. [DOI: 10.1007/s11414-018-9624-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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23
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LeFebvre AM, Dare B, Farrell SJ, Cuddeback GS. Transitions from Assertive Community Treatment Among Urban and Rural Teams: Identifying Barriers, Service Options, and Strategies. Community Ment Health J 2018; 54:469-479. [PMID: 28864952 DOI: 10.1007/s10597-017-0162-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
Abstract
An emerging focus of Assertive Community Treatment (ACT) teams is the transition of clients to less intensive services, which creates space for individuals in need of ACT and is consistent with a recovery orientation of treatment. However, there is limited research on team transition rates, post-ACT services, and strategies to overcome transition barriers. In addition, few studies have examined differences in these factors among urban and rural ACT teams. To address these knowledge gaps, we interviewed eight ACT teams in urban and rural areas of eastern Ontario regarding their transition rates, processes of transitioning ACT clients to less intensive services, transition barriers, and solutions to overcoming these barriers. On average, teams transitioned about 6% of their clients over our 3-year study period. Urban and rural teams described both similar and distinct clinical and systemic barriers, such as client reluctance to transition and finding psychiatric follow-up outside of ACT. Implications for ACT practice and policy are discussed.
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Affiliation(s)
- Andrea M LeFebvre
- Community Mental Health Program, The Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada.
| | - Bill Dare
- Community Mental Health Program, The Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada
| | - Susan J Farrell
- Community Mental Health Program, The Royal Ottawa Health Care Group, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada.,Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - Gary S Cuddeback
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA
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Tomar N, Ghezzi MA, Brinkley-Rubinstein L, Wilson AB, Van Deinse TB, Burgin S, Cuddeback GS. Statewide mental health training for probation officers: improving knowledge and decreasing stigma. Health Justice 2017; 5:11. [PMID: 29143153 PMCID: PMC5688049 DOI: 10.1186/s40352-017-0057-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/06/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The large and growing number of probationers with mental illnesses pose significant challenges to the probationer officers who supervise them. Stigma towards mental illnesses among probation officers is largely unstudied and the effectiveness of training initiatives designed to educate probation officers about mental illness is unknown. To address these gaps in the literature, we report findings from a statewide mental health training initiative designed to improve probation officers' knowledge of mental illnesses. A single-group pretest posttest design was used and data about stigma towards mental illnesses and knowledge of mental illnesses were collected from 316 probation officers. Data were collected prior to and shortly after officers viewed a series of educational training modules about mental illnesses. RESULTS Officers' knowledge of mental illnesses increased and officers demonstrated lower levels of stigma towards persons with mental illnesses as evidenced by scores on a standardized scale. CONCLUSION Mental health education can help decrease stigma and increase knowledge of mental illnesses among probation officers. More research is needed to assess the impact of these trainings on probationers' mental health and criminal justice outcomes.
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Affiliation(s)
- Nikhil Tomar
- Division of Occupational Science and Occupational Therapy, University of North Carolina at Chapel Hill, 321 South Columbia Street, CB#7122, Chapel Hill, NC, 27599, USA.
| | - Marilyn A Ghezzi
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA
| | - Lauren Brinkley-Rubinstein
- School of Medicine, Department of Social Medicine and Center for Health Equity Research, University of North Carolina at Chapel Hill, 333 South Columbia Street, CB#7240, Chapel Hill, NC, 27599, USA
| | - Amy Blank Wilson
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA
| | - Tonya B Van Deinse
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA
| | - Stacey Burgin
- School of Medicine, Department of Psychiatry, Center for Excellence in Community Mental Health, University of North Carolina at Chapel Hill, 200 N. Greensboro St., Suite C-6, Carrboro, NC, 27510, USA
| | - Gary S Cuddeback
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro Street, CB#3550, Chapel Hill, NC, 27599, USA
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Grabert BK, Gertner AK, Domino ME, Cuddeback GS, Morrissey JP. Expedited Medicaid Enrollment, Service Use, and Recidivism at 36 Months Among Released Prisoners With Severe Mental Illness. Psychiatr Serv 2017; 68:1079-1082. [PMID: 28457211 DOI: 10.1176/appi.ps.201600482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined long-term outcomes (at 36 months) from Washington State's policy of expediting Medicaid enrollment for prison releasees with severe mental illness and compares them with previously reported short-term outcomes (at 12 months). METHODS Linked administrative data on prison releasees (2006-2007) were analyzed by using a quasi-experimental design comparing those referred to expedited Medicaid (N=895) with a control group of those not referred (N=2,189). Aggregate outcomes were analyzed with inverse probability of treatment-weighted logit models. RESULTS Expedited Medicaid had a sustained effect on both increased months of enrollment (p<.01) and increased use of community mental health and general medical services (p<.01) 36 months after prison release. However, expedited Medicaid did not reduce criminal recidivism, consistent with 12-month findings, Conclusions: Outcome results at 12 months were sustained at 36 months-namely, expedited Medicaid for released prisoners with severe mental illness improved enrollment and service use with no effects on criminal recidivism.
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Affiliation(s)
- Brigid K Grabert
- Ms. Grabert, Mr. Gertner, Dr. Domino, and Dr. Morrissey are with the Department of Health Policy and Management, Gillings School of Global Public Health, and Dr. Cuddeback is with the School of Social Work, University of North Carolina, Chapel Hill. The authors are also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
| | - Alex K Gertner
- Ms. Grabert, Mr. Gertner, Dr. Domino, and Dr. Morrissey are with the Department of Health Policy and Management, Gillings School of Global Public Health, and Dr. Cuddeback is with the School of Social Work, University of North Carolina, Chapel Hill. The authors are also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
| | - Marisa Elena Domino
- Ms. Grabert, Mr. Gertner, Dr. Domino, and Dr. Morrissey are with the Department of Health Policy and Management, Gillings School of Global Public Health, and Dr. Cuddeback is with the School of Social Work, University of North Carolina, Chapel Hill. The authors are also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
| | - Gary S Cuddeback
- Ms. Grabert, Mr. Gertner, Dr. Domino, and Dr. Morrissey are with the Department of Health Policy and Management, Gillings School of Global Public Health, and Dr. Cuddeback is with the School of Social Work, University of North Carolina, Chapel Hill. The authors are also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
| | - Joseph P Morrissey
- Ms. Grabert, Mr. Gertner, Dr. Domino, and Dr. Morrissey are with the Department of Health Policy and Management, Gillings School of Global Public Health, and Dr. Cuddeback is with the School of Social Work, University of North Carolina, Chapel Hill. The authors are also with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
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Van Dorn RA, Desmarais SL, Rade CB, Burris EN, Cuddeback GS, Johnson KL, Tueller SJ, Comfort ML, Mueser KT. Jail-to-community treatment continuum for adults with co-occurring substance use and mental disorders: study protocol for a pilot randomized controlled trial. Trials 2017; 18:365. [PMID: 28778175 PMCID: PMC5545037 DOI: 10.1186/s13063-017-2088-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adults with co-occurring mental and substance use disorders (CODs) are overrepresented in jails. In-custody barriers to treatment, including a lack of evidence-based treatment options and the often short periods of incarceration, and limited communication between jails and community-based treatment agencies that can hinder immediate enrollment into community care once released have contributed to a cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among this vulnerable and high-risk population. This paper describes a study that will develop research and communication protocols and adapt two evidence-based treatments, dual-diagnosis motivational interviewing (DDMI) and integrated group therapy (IGT), for delivery to adults with CODs across a jail-to-community treatment continuum. METHODS/DESIGN Adaptations to DDMI and IGT were guided by the Risk-Need-Responsivity model and the National Institute of Corrections' implementation competencies; the development of the implementation framework and communication protocols were guided by the Evidence-Based Interagency Implementation Model for community corrections and the Inter-organizational Relationship model, respectively. Implementation and evaluation of the protocols and adapted interventions will occur via an open trial and a pilot randomized trial. The clinical intervention consists of two in-jail DDMI sessions and 12 in-community IGT sessions. Twelve adults with CODs and four clinicians will participate in the open trial to evaluate the acceptability and feasibility of, and fidelity to, the interventions and research and communication protocols. The pilot controlled trial will be conducted with 60 inmates who will be randomized to either DDMI-IGT or treatment as usual. A baseline assessment will be conducted in jail, and four community-based assessments will be conducted during a 6-month follow-up period. Implementation, clinical, public health, and treatment preference outcomes will be evaluated. DISCUSSION Findings have the potential to improve both jail- and community-based treatment services for adults with CODs as well as inform methods for conducting rigorous pilot implementation and evaluation research in correctional settings and as inmates re-enter the community. Findings will contribute to a growing area of work focused on interrupting the cycle of limited treatment engagement, unaddressed criminogenic risks, and (re)arrest among adults with CODs. TRIAL REGISTRATION ClinicalTrials.gov, NCT02214667 . Registered on 10 August 2014.
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Affiliation(s)
- Richard A Van Dorn
- Urban Health Program, RTI International, Research Triangle Park, 3040 E. Cornwallis Road, P.O. Box 12194, Durham, NC, 27709, USA.
| | - Sarah L Desmarais
- Department of Psychology, North Carolina State University, Raleigh, NC, 27695, USA
| | - Candalyn B Rade
- Department of Psychology, North Carolina State University, Raleigh, NC, 27695, USA
| | - Elizabeth N Burris
- Department of Psychology, North Carolina State University, Raleigh, NC, 27695, USA
| | - Gary S Cuddeback
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kiersten L Johnson
- Urban Health Program, RTI International, Research Triangle Park, 3040 E. Cornwallis Road, P.O. Box 12194, Durham, NC, 27709, USA
| | - Stephen J Tueller
- Risk Behavior and Family Research Program, RTI International, Research Triangle Park, Durham, NC, 27709, USA
| | - Megan L Comfort
- Urban Health Program, RTI International, Research Triangle Park, 3040 E. Cornwallis Road, P.O. Box 12194, Durham, NC, 27709, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, 02215, USA
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Abstract
Large urban jails have become a collection point for many persons with severe mental illness. Connections between jail and community mental health services are needed to assure in-jail care and to promote successful community living following release. This paper addresses this issue for 2855 individuals with severe mental illness who received community mental health services prior to jail detention in King County (Seattle), Washington over a 5-year time period using a unique linked administrative data source. Logistic regression was used to determine the probability that a detainee with severe mental illness received mental health services while in jail as a function of demographic and clinical characteristics. Overall, 70 % of persons with severe mental illness did receive in-jail mental health treatment. Small, but statistically significant sex and race differences were observed in who received treatment in the jail psychiatric unit or from the jail infirmary. Findings confirm the jail's central role in mental health treatment and emphasize the need for greater information sharing and collaboration with community mental health agencies to minimize jail use and to facilitate successful community reentry for detainees with severe mental illness.
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Affiliation(s)
- Sean K Sayers
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marisa E Domino
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Department of Health Policy and Management, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1104G McGavran-Greenberg Hall, CB#7411, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA.
| | - Gary S Cuddeback
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nadine J Barrett
- Office of Health Equity and Disparities, Duke Cancer Institute, Durham, NC, USA.,Duke Community Connections and Collaborations Core, Duke Center for Community and Population Health Improvement and Clinical Translational Science Award, Durham, NC, USA.,Department of Community and Family Medicine, School of Medicine, Duke University, Durham, NC, USA
| | - Joseph P Morrissey
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Health Policy and Management, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1104G McGavran-Greenberg Hall, CB#7411, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA
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Cuddeback GS, Kurtz RA, Wilson AB, VanDeinse T, Burgin SE. Segmented Versus Traditional Crisis Intervention Team Training. J Am Acad Psychiatry Law 2016; 44:338-343. [PMID: 27644867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There are more than 2,500 Crisis Intervention Teams (CIT) in operation across the country. Results of research on the effectiveness and impact of CIT are mixed. One aspect of CIT training that has yet to be examined is the expert-derived suggestion that 40 consecutive hours of training is an essential element of CIT for law enforcement officers. That is, CIT training is delivered in one 40-hour week, but it is unclear whether the training could be delivered in segments and still achieve its desired outcomes. Segmented training could make CIT more accessible to smaller, particularly rural, law enforcement agencies. Can segmented CIT achieve outcomes similar to those of traditional CIT training? We compared the knowledge and attitudes of 47 police officers who received traditional CIT training and 32 officers who received segmented CIT training. Our findings suggest that segmented CIT training and traditional CIT training produce comparable results regarding officers' knowledge of mental illness and attitudes toward persons with mental illness, providing preliminary support for this adaptation to the delivery of CIT training.
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Affiliation(s)
- Gary S Cuddeback
- Dr. Wilson is an assistant professor. Dr. Cuddeback is an associate professor. Ms. VanDeinse is a doctoral candidate, and Ms. Burgin is a research associate, School of Social Work, University of North Carolina, Chapel Hill, NC. Dr. Kurtz is Program Manager, Justice System Team, Community Policy Management Section, Division of MH/DD/SAS, Raleigh, NC.
| | - Robert A Kurtz
- Dr. Wilson is an assistant professor. Dr. Cuddeback is an associate professor. Ms. VanDeinse is a doctoral candidate, and Ms. Burgin is a research associate, School of Social Work, University of North Carolina, Chapel Hill, NC. Dr. Kurtz is Program Manager, Justice System Team, Community Policy Management Section, Division of MH/DD/SAS, Raleigh, NC
| | - Amy Blank Wilson
- Dr. Wilson is an assistant professor. Dr. Cuddeback is an associate professor. Ms. VanDeinse is a doctoral candidate, and Ms. Burgin is a research associate, School of Social Work, University of North Carolina, Chapel Hill, NC. Dr. Kurtz is Program Manager, Justice System Team, Community Policy Management Section, Division of MH/DD/SAS, Raleigh, NC
| | - Tonya VanDeinse
- Dr. Wilson is an assistant professor. Dr. Cuddeback is an associate professor. Ms. VanDeinse is a doctoral candidate, and Ms. Burgin is a research associate, School of Social Work, University of North Carolina, Chapel Hill, NC. Dr. Kurtz is Program Manager, Justice System Team, Community Policy Management Section, Division of MH/DD/SAS, Raleigh, NC
| | - Stacey E Burgin
- Dr. Wilson is an assistant professor. Dr. Cuddeback is an associate professor. Ms. VanDeinse is a doctoral candidate, and Ms. Burgin is a research associate, School of Social Work, University of North Carolina, Chapel Hill, NC. Dr. Kurtz is Program Manager, Justice System Team, Community Policy Management Section, Division of MH/DD/SAS, Raleigh, NC
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Morrissey JP, Domino ME, Cuddeback GS. Expedited Medicaid Enrollment, Mental Health Service Use, and Criminal Recidivism Among Released Prisoners With Severe Mental Illness. Psychiatr Serv 2016; 67:842-9. [PMID: 26975522 PMCID: PMC4969154 DOI: 10.1176/appi.ps.201500305] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study investigated whether Washington State's 2006 policy of expediting Medicaid enrollment for offenders with severe mental illness released from state prisons increased Medicaid access and use of community mental health services while decreasing criminal recidivism. METHODS A quasi-experimental design with linked administrative data was used to select all prisoners with a severe mental illness (schizophrenia or bipolar disorder) released during the policy's first two years (January 1, 2006, through December 31, 2007), and those referred for expedited Medicaid (N=895) were separated from a propensity-weighted control group of those not referred (N=2,191). Measures included binary indicators of Medicaid enrollment, other public insurance enrollment, postrelease use of inpatient and outpatient health services, and any postrelease criminal justice contacts. All data were collapsed to person-level observations during the 12 months after the index release, and outcomes were estimated via propensity-weighted logit models. RESULTS Referral for expedited Medicaid on release from prison greatly increased Medicaid enrollment (p<.01) and use of community mental health and general medical services (p<.01) for persons with severe mental illness. No evidence was found that expediting Medicaid reduced criminal recidivism. CONCLUSIONS Expediting Medicaid was associated with increased Medicaid enrollment and both mental health and general medical service use, but study findings strongly suggest that rather than relying on indirect spillover effects from Medicaid to reduce criminal recidivism, advocates and policy makers would better address the needs of offenders with severe mental illness through direct interventions targeted at underlying causes of recidivism.
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Affiliation(s)
- Joseph P Morrissey
- Dr. Morrissey and Dr. Domino are with the Department of Health Policy and Management, Gillings School of Global Public Health, Dr. Cuddeback is with the School of Social Work, and all three are with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (e-mail: )
| | - Marisa E Domino
- Dr. Morrissey and Dr. Domino are with the Department of Health Policy and Management, Gillings School of Global Public Health, Dr. Cuddeback is with the School of Social Work, and all three are with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (e-mail: )
| | - Gary S Cuddeback
- Dr. Morrissey and Dr. Domino are with the Department of Health Policy and Management, Gillings School of Global Public Health, Dr. Cuddeback is with the School of Social Work, and all three are with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill (e-mail: )
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Cuddeback GS, Morrissey JP, Domino ME. Enrollment and Service Use Patterns Among Persons With Severe Mental Illness Receiving Expedited Medicaid on Release From State Prisons, County Jails, and Psychiatric Hospitals. Psychiatr Serv 2016; 67:835-41. [PMID: 26975523 DOI: 10.1176/appi.ps.201500306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined postrelease patterns of Medicaid coverage and use of services among persons with severe mental illness who were referred for expedited Medicaid enrollment before their release from state prisons, county jails, and psychiatric hospitals in Washington State during 2006, the first year of a new policy authorizing this practice. METHODS A retrospective cohort design was used with linked administrative data to identify persons with severe mental illness (schizophrenia, bipolar disorder, or major depression) who were referred for expedited Medicaid enrollment from state prisons (N=252), county jails (N=489), and psychiatric hospitals (N=507). For each cohort, logistic regression was used to compare those who were approved for expedited Medicaid with those who were not approved; for the 30-, 60-, and 90-day periods after release, Medicaid enrollment status and use of outpatient mental health services were also compared. RESULTS Approval rates were higher for persons released from psychiatric hospitals (91%) and state prisons (83%) than for those released from jails (66%) (p<.001). Across settings, approval was more likely for those with a diagnosis of schizophrenia and for women (p<.001), as well as for whites and older offenders (p<.01). At the 90-day follow-up, those who were approved were more likely than those who were denied to be enrolled in Medicaid (p<.001) and to have used outpatient mental health services (p<.001). CONCLUSIONS Expediting Medicaid benefits for persons with severe mental illness was associated with increased enrollment and outpatient mental health service use in the 90 days after release from state prisons, county jails, and psychiatric hospitals in Washington State.
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Affiliation(s)
- Gary S Cuddeback
- Dr. Cuddeback is with the School of Social Work, Dr. Morrissey and Dr. Domino are with the Department of Health Policy and Management, Gillings School of Global Public Health, and all three are with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill. Send correspondence to Dr. Morrissey (e-mail: )
| | - Joseph P Morrissey
- Dr. Cuddeback is with the School of Social Work, Dr. Morrissey and Dr. Domino are with the Department of Health Policy and Management, Gillings School of Global Public Health, and all three are with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill. Send correspondence to Dr. Morrissey (e-mail: )
| | - Marisa E Domino
- Dr. Cuddeback is with the School of Social Work, Dr. Morrissey and Dr. Domino are with the Department of Health Policy and Management, Gillings School of Global Public Health, and all three are with the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill. Send correspondence to Dr. Morrissey (e-mail: )
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Cuddeback GS, Wright D, Bisig NG. Characteristics of participants in jail diversion and prison reentry programs: implications for forensic ACT. Psychiatr Serv 2013; 64:1043-6. [PMID: 24081403 DOI: 10.1176/appi.ps.201200333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE More research is needed about forensic assertive community treatment (FACT) and challenges that offenders with severe mental illness present to jail diversion and prison reentry teams. Jail diversion and prison reentry populations may require different interventions and strategies to engage and serve them. METHODS This study used data from a mental health agency in a large urban area in Ohio to compare the demographic and clinical characteristics of 212 consumers served by jail diversion FACT teams and 192 consumers served by prison reentry FACT teams. RESULTS Findings suggest that jail diversion and prison reentry consumers have different demographic and clinical profiles, which may present unique challenges to FACT teams. CONCLUSIONS Population- and gender-specific strategies and interventions could be warranted to better serve FACT consumers. This study furthers the literature about the needs of justice-involved consumers and offers important information for providers of FACT for jail diversion and prison reentry.
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Cuddeback GS, Shattell MM, Bartlett R, Yoselle J, Brown D. Consumers’ Perceptions of Transitions from Assertive Community Treatment to Less Intensive Services. J Psychosoc Nurs Ment Health Serv 2013; 51:39-45. [DOI: 10.3928/02793695-20130603-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 04/19/2013] [Indexed: 11/20/2022]
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Yoon J, Domino ME, Norton EC, Cuddeback GS, Morrissey JP. The impact of changes in psychiatric bed supply on jail use by persons with severe mental illness. J Ment Health Policy Econ 2013; 16:81-92. [PMID: 23999205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 05/17/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND There is an on-going concern that reductions in psychiatric inpatient bed capacity beyond a critical threshold will further exacerbate the incarceration of persons with mental illness. However, research to date to assess the proposed relationship between inpatient bed capacity and jail use has been limited in several ways. In addition, mechanisms through which changes in psychiatric bed capacity may affect jail use by persons with mental illness remain unexamined empirically. AIMS OF THE STUDY The aim of this study is to test whether changes in inpatient psychiatric resources, measured by per-capita psychiatric beds, inversely affect the likelihood of jail use by persons with severe mental illness. We also examine mechanisms that link psychiatric bed supply and jail detention. METHODS We analyze unique individual-level panel data on 41,236 adults in King County, Washington who were users of jails, the public mental health system, or the Medicaid program from 1993 to 1998. Using administrative records, we identify persons ever diagnosed with severe mental illness during the study period. Our analyses build upon a system of simultaneous equations that captures mechanisms from changes in psychiatric bed supply to jail detention. We estimate a reduced-form model and calculate the total effect of a shift in psychiatric bed supply on the likelihood of jail use by persons with severe mental illness. We also estimate a semi-reduced-form equation to examine whether changes in mental health and substance use mediate the relationship between bed supply and jail detention. We estimate linear probability models with person-level fixed effects to control for individual heterogeneity. Standard errors are adjusted for intra-cluster correlations. When an equation includes an endogenous variable, we calculate generalized method of moments estimators with instrumental variables. RESULTS A decrease in the supply of psychiatric hospital beds is significantly associated with a greater probability of jail detention for minor charges among persons diagnosed with severe mental illness. Substance use appears to mediate this relationship. DISCUSSION A reduction of inpatient psychiatric beds, ceteris paribus, is associated with an increase in jail detention among persons with severe mental illness via substance use problems. Further research should examine whether the magnitude of this relationship is greater for persons who have severe mental illness but are unable to obtain necessary treatment. IMPLICATIONS FOR HEALTH POLICIES This study further confirms an identified relationship between the supply of inpatient psychiatric beds, substance use and jail detention among persons with severe mental illness. These important relationships should be incorporated in the policy planning process, especially at the time of psychiatric inpatient bed reductions.
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Affiliation(s)
- Jangho Yoon
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331-6406, USA.
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Abstract
OBJECTIVE A previous study of a recovery-oriented assertive community treatment initiative (PACT) in Washington State found reductions in state psychiatric hospital use and related costs for PACT participants, especially in the first six months after enrollment and for consumers who were high users of the state psychiatric hospital before ACT enrollment. This study examined whether these outcomes varied by team fidelity to recovery-oriented ACT practices. METHODS Generalized estimating equations (GEE) were used to examine the relationship between scores on the Tool for Measurement of Assertive Community Treatment (TMACT), a recently developed tool for assessing fidelity to recovery-oriented ACT, and the use of state hospitals, local hospitals, emergency departments, local crisis stabilization units, and arrests for 631 PACT consumers. These relationships were also examined for PACT consumers with any state hospital use (N=450) and those considered high users of the state hospital (≥ 96 days in two years before PACT enrollment). RESULTS TMACT scores were associated (p<.01) with a decrease in the amount of use but not the probability of using state psychiatric hospitals, local hospital psychiatric inpatient units, and local crisis stabilization units. The marginal effects of higher TMACT scores on the probability and use of emergency departments or arrests were not statistically significant. CONCLUSIONS This study provides preliminary evidence for the predictive validity of the TMACT. Future research should examine the subscale structure of the TMACT as well as the association between TMACT fidelity and consumer well-being, quality of life, and other important person-centered outcomes.
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Affiliation(s)
- Gary S Cuddeback
- Cecil G. Sheps Center for Health Services Research, University of North Carolina (UNC), Chapel Hill. Dr. Cuddeback is also with the School of Social Work, UNC, 325 Pittsboro St., CB#3550, Chapel Hill, NC 27599, USA.
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Abstract
OBJECTIVE The purpose of this study was to assess the effectiveness of Washington State's PACT, a recovery-oriented assertive community treatment (ACT) initiative, in reducing state psychiatric hospital use. METHODS A quasi-experimental design and administrative data were used to compare 450 PACT consumers and 450 propensity score-matched consumers receiving usual care. Generalized estimating equations (GEE) assessed the effects of PACT on use of state and local hospitals, emergency departments, crisis stabilization units, and arrests. The marginal effects of PACT were estimated for high users and low users of state hospitals at baseline. RESULTS No difference between PACT participants and control participants was observed in the probability of having any state hospital use. A reduction in state hospital use of between 32 and 33 days per person per year was observed (p<.01). Reductions in state hospital costs were concentrated among PACT participants who had high state hospital use at baseline; cost reductions ranged from about $17,000 to $20,000 per person per year (p<.01). State hospital cost reductions were partially offset by increases in use of local services, with small but significant (p<.01) increases in local hospital use, use of emergency departments, and use of crisis stabilization services. CONCLUSIONS PACT had its greatest effects for consumers who were high utilizers of state psychiatric hospitals at baseline. Contrary to studies and commentaries from the United Kingdom, ACT remains a viable intervention in areas where state hospitals are overused. Whether blending traditional ACT with recovery-oriented practices also promotes consumer recovery requires further study.
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Affiliation(s)
- Joseph P Morrissey
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, 725 Martin Luther King, Jr. Blvd., Chapel Hill, NC 27599-7590, USA.
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Abstract
OBJECTIVE A previous study of recovery-oriented assertive community treatment (PACT) found large differences over three years in use of state psychiatric hospitals between PACT participants and consumers in a matched control group, especially for PACT participants with significant previous psychiatric hospitalization. This study extended these findings by examining the timing of PACT effects. METHODS Generalized estimating equation models of monthly cost data for state, local, and crisis hospital use estimated the time-varying effects of participation in one of ten PACT teams in Washington State. Data from PACT participants (N=450) and propensity score-matched consumers (N=450) were included. Additional analyses determined whether effects differed by prior state hospital use. RESULTS Differences in costs between PACT and control participants were largest immediately after PACT enrollment and tapered off. During the first quarter after enrollment, monthly per-person costs for state hospital use were $3,458 lower for PACT enrollees than for control participants. A composite measure of psychiatric hospital costs (state and local hospitals and local crisis stabilization units) declined by $3,539 monthly during the first quarter after PACT enrollment (p<.01). Differences were noted up to 27 months after enrollment, when the difference in the composite costs measure became insignificant compared with the prior quarter (months 25-27) (p>.05). Differences were larger for PACT enrollees with greater baseline state hospital use. CONCLUSIONS The time-varying estimates may have implications for the length and intensity of ACT enrollment. However, the optimum time for receipt of ACT services needs to be considered in the context of outcomes other than hospitalization alone.
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Affiliation(s)
- Marisa E Domino
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, 725 Martin Luther King, Jr. Blvd., Chapel Hill, NC 27599-7590, USA.
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Gayman MD, Cuddeback GS, Morrissey JP. Help-seeking behaviors in a community sample of young adults with substance use disorders. J Behav Health Serv Res 2012; 38:464-77. [PMID: 21523514 DOI: 10.1007/s11414-011-9243-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite the high prevalence of substance use disorders (SUDs) in the U.S., many with a SUD go untreated and/or report lengthy delays to help-seeking initiation. From a public health standpoint, because SUDs often emerge in early adulthood, information on help-seeking behaviors among young adults is important. Using data from young adults ages 18-23 years with a history of a SUD (n = 672) in Miami-Dade County, Florida, this study estimates the prevalence of lifetime help-seeking initiation and examines factors related to help seeking and delays to help-seeking initiation. The majority (68%) of young adults with a history of a SUD reported never having sought help, and those who reported help seeking experienced relatively lengthy delays (1-7 years) to help-seeking initiation. These findings underscore the need for both timely substance abuse treatment and for accelerated research on successful outreach strategies for young adults with SUDs.
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Affiliation(s)
- Mathew D Gayman
- Department of Sociology, Affiliated Faculty, Partnership for Urban Health Research, Georgia State University, 1080-A, PO Box 5020, Atlanta, GA 30302-5020, USA.
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Cuddeback GS, Morrissey JP. Program planning and staff competencies for forensic assertive community treatment: ACT-eligible versus FACT-eligible consumers. J Am Psychiatr Nurses Assoc 2011; 17:90-7. [PMID: 21659299 PMCID: PMC3653310 DOI: 10.1177/1078390310392374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Forensic assertive community treatment (FACT) is a recent adaptation of the assertive community treatment (ACT) model; however, more information is needed about how FACT and ACT consumers differ and how FACT should be modified to accommodate these differences. METHOD Linked, multisystem administrative data from King County, Washington, were used to compare the demographic, clinical, and criminal justice characteristics of ACT- and FACT-eligible consumers. RESULTS FACT consumers were more likely to be male, persons of color, and had more complex clinical profiles. Also, some FACT consumers were incarcerated for sex offenses, and more than half had violent offenses. CONCLUSIONS Traditionally, ACT teams avoid serving consumers with personality disorders, violent consumers, and sex offenders; however, given increased use of mandated outpatient treatment and mental health courts, FACT teams may have less discretion to choose whom they serve. The addition of clinical interventions and other modifications may be particularly important for FACT teams.
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Affiliation(s)
- Gary S Cuddeback
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Shattell MM, Donnelly N, Scheyett A, Cuddeback GS. Assertive community treatment and the physical health needs of persons with severe mental illness: issues around integration of mental health and physical health. J Am Psychiatr Nurses Assoc 2011; 17:57-63. [PMID: 21659295 DOI: 10.1177/1078390310393737] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assertive community treatment (ACT) is characterized as a service delivery platform and represents an ideal setting in which mental health and physical health care can be integrated. OBJECTIVE Little is known about the extent to which ACT integrates physical health care with mental health care or the challenges ACT teams experience. To address this gap, focus groups were conducted with five ACT teams in a Midwestern US state to explore how ACT teams address the physical health care needs of persons with severe mental illness. DESIGN A qualitative study design was used. RESULTS Three major themes emerged: ACT teams recognize serious and chronic physical health problems, ACT teams take on a variety of roles to address physical health problems, and there are challenges to integrating primary and mental health care within an ACT setting. CONCLUSIONS ACT needs to be adapted to incorporate promising practices designed to better integrate physical health care and mental health care.
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Affiliation(s)
- Mona M Shattell
- School of Nursing, University of North Carolina at Greensboro, Greensboro, NC 27402, USA.
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40
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Abstract
OBJECTIVE This study examined whether the proportion as well as the number of prisoners with behavioral health disorders have increased in recent years. METHODS Among 41,440 persons admitted to Washington State prisons from 1998 through 2006, this study estimated numbers and proportions of behavioral health disorders diagnosed while persons were in the community or in prison. RESULTS There was a 44% increase in persons admitted with a diagnosed co-occurring substance use disorder between 1998 (N=477) and 2005 (N=686); this increase dropped to 27% by 2006 (N=604). Ratewise, increases in the annual proportion of persons admitted with co-occurring disorders were much smaller, ranging from approximately .2% to 2.6%. CONCLUSIONS The growth in the numbers of prisoners with serious mental illness and co-occurring substance use disorders was not due primarily to increases in admission base rates. Nevertheless, more treatment resources will be needed in prisons to meet growing mental health care needs, and more community-based resources will be needed to ensure continuity of treatment and successful community reentry.
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Affiliation(s)
- Mindy S Bradley-Engen
- Department of Sociology and Criminal Justice, University of Arkansas, 211 Old Main, Fayetteville, AR 72701, USA.
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Cusack KJ, Morrissey JP, Cuddeback GS, Prins A, Williams DM. Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: a randomized trial. Community Ment Health J 2010; 46:356-63. [PMID: 20217230 PMCID: PMC2895013 DOI: 10.1007/s10597-010-9299-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 02/17/2010] [Indexed: 11/27/2022]
Abstract
Jail diversion and forensic community treatment programs have proliferated over the past decade, far outpacing evidence regarding their efficacy. The current study reports findings from a randomized clinical trial conducted in California for frequent jail users with serious mental illness that compares a forensic assertive community treatment (FACT) intervention with treatment as usual (TAU). Outcomes are reported at 12 and 24 months post-randomization for criminal justice outcomes, behavioral health services and costs. At 12 months, FACT vs. TAU participants had fewer jail bookings, greater outpatient contacts, and fewer hospital days than did TAU participants. Results of zero-inflated negative binomial regression found that FACT participants had a higher probability of avoiding jail, although once jailed, the number of jail days did not differ between groups. Increased outpatient costs resulting from FACT outpatient services were partially offset by decreased inpatient and jail costs. The findings for the 24 month period followed the same pattern. These findings provide additional support for the idea that providing appropriate behavioral health services can reduce criminal justice involvement.
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Affiliation(s)
- Karen J Cusack
- Department of Psychiatry and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Cuddeback GS, Scheyett A, Pettus-Davis C, Morrissey JP. General medical problems of incarcerated persons with severe and persistent mental illness: a population-based study. Psychiatr Serv 2010; 61:45-9. [PMID: 20044417 PMCID: PMC2829837 DOI: 10.1176/appi.ps.61.1.45] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Persons with severe mental illness have higher rates of chronic general medical illness compared with the general population. Similarly, compared with the general population, incarcerated persons have higher rates of chronic medical illness; however, there is little information about the synergy between severe mental illness and incarceration and the general medical problems of consumers. To address this gap in the literature this study addressed the following question: are consumers with a history of incarceration at greater risk of general medical problems compared with consumers without such a history? METHODS Administrative data were used to compare the medical problems of 3,690 persons with severe mental illness with a history of incarceration and 2,042 persons with severe mental illness with no such history. RESULTS Consumers with a history of incarceration were more likely than those with no such history to have infectious, blood, and skin diseases and a history of injury. Furthermore, when analyses controlled for gender, race, age, and substance use disorders, consumers with an incarceration history were 40% more likely to have any general medical problem and 30% more likely to have multiple medical problems. CONCLUSIONS The findings presented here call for better communication among local public health and mental health providers and jails and better integration of primary care and behavioral health care among community mental health providers. Also, research should be accelerated on evidence-based interventions designed to divert persons with severe mental illness from the criminal justice system and facilitate community reentry for persons with severe mental illness who are released from jails and prisons.
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Affiliation(s)
- Gary S Cuddeback
- Cecil G. Sheps Center for HealthServices Research, Chapel Hill, North Carolina, USA.
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Abstract
Despite the growing interest in forensic assertive community treatment (FACT), there is no standardized definition of FACT eligibility and no guidelines for how many FACT teams communities may need. In this brief report a definition for FACT eligibility is proposed-severe and persistent mental illness and three jail detentions in a one-year period-and modeled by using 5.5 years of administrative data (July 1, 1993, through December 31, 1998) from a large, urban county in the western United States. Findings suggest that large, urban communities should develop enough FACT teams to serve approximately 44% of their populations of persons with severe mental illness, or roughly .05% of their adult populations. Developing standardized eligibility criteria for FACT is an important first step toward developing its evidence base.
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Affiliation(s)
- Gary S Cuddeback
- Cecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., CB 7590, Chapel Hill, NC 27599, USA.
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44
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Abstract
Despite the growing interest in forensic assertive community treatment (FACT), there is no standardized definition of FACT eligibility and no guidelines for how many FACT teams communities may need. In this brief report a definition for FACT eligibility is proposed-severe and persistent mental illness and three jail detentions in a one-year period-and modeled by using 5.5 years of administrative data (July 1, 1993, through December 31, 1998) from a large, urban county in the western United States. Findings suggest that large, urban communities should develop enough FACT teams to serve approximately 44% of their populations of persons with severe mental illness, or roughly .05% of their adult populations. Developing standardized eligibility criteria for FACT is an important first step toward developing its evidence base.
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Affiliation(s)
- Gary S Cuddeback
- Cecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., CB 7590, Chapel Hill, NC 27599, USA.
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Morrissey JP, Cuddeback GS, Cuellar AE, Steadman HJ. The role of Medicaid enrollment and outpatient service use in jail recidivism among persons with severe mental illness. Psychiatr Serv 2007; 58:794-801. [PMID: 17535939 DOI: 10.1176/ps.2007.58.6.794] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to determine whether having Medicaid benefits and receiving behavioral health services are associated with a reduction in recidivism for jail detainees with severe mental illness. METHODS A quasi-experimental design with linked administrative data was used. All persons released over a two-year period from jails in King County, Washington (N=5,189), and Pinellas County, Florida (N=2,419), who had severe mental illness were followed for 12 months after jail release. Those who were receiving Medicaid benefits at release and those who were not were compared on three indicators: how many subsequent arrests occurred, how soon the arrest occurred, and how serious the associated offense was. The data were analyzed with negative binomial, Cox proportional hazards models and logistic regression with adjustments for dependent observations. RESULTS In both counties, having Medicaid at release was associated with a 16% reduction in the average number of subsequent detentions (p<.001 and p<.01, respectively). After the analysis controlled for demographic and clinical variables, more days on Medicaid were associated with a reduced number of subsequent detentions in King County (p<.001) and more days in the community before subsequent arrest in both counties (p<.01 and p<.05, respectively). No association was found between Medicaid status and the seriousness of the subsequent offense in either county. CONCLUSIONS Although Medicaid benefits and behavioral health services were associated with fewer rearrests and more time in the community, the observed differences were relatively small. Further research is needed to determine how greater reductions in jail recidivism can be achieved for this target population.
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Affiliation(s)
- Joseph P Morrissey
- Department of Health Policy and Administration, School of Public Health and the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599-7590, USA.
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46
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Abstract
OBJECTIVE Assertive community treatment (ACT) reduces hospitalizations for persons with severe mental illness. However, not everyone who needs ACT receives it. Without empirical guidelines for ACT planning, communities are likely to underestimate or overestimate the number of teams they need; thus the capacity of the programs will not meet current needs. In this study, administrative data were used to develop empirical estimates for the number of required ACT teams. These estimates were then used to examine current conceptual guidelines for developing the number of ACT teams that communities need. METHODS Administrative data from a large, urban county were used to enumerate all persons with a severe mental illness who had three or more hospitalizations within one year (ACT eligible). RESULTS Fifty-one percent of persons with a severe mental illness were found to be eligible for ACT (743 of 1,453 persons). This figure represents 2.2 percent of the county's mental health users and .06 percent of its adult population. CONCLUSIONS Communities should develop enough ACT teams to serve approximately 50 percent of their populations of persons with severe mental illness or roughly .06 percent of their adult populations.
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Affiliation(s)
- Gary S Cuddeback
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, CB#7590, 725 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27599-7590, USA.
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47
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Morrissey JP, Steadman HJ, Dalton KM, Cuellar A, Stiles P, Cuddeback GS. Medicaid enrollment and mental health service use following release of jail detainees with severe mental illness. Psychiatr Serv 2006; 57:809-15. [PMID: 16754757 DOI: 10.1176/ps.2006.57.6.809] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study assessed the extent to which Medicaid enrollment increased access to and use of services by persons with severe mental illness after their release from jail. METHODS A prospective cohort design was used that linked administrative data from several agencies in two large urban areas: King County (Seattle) from 1996 to 1998 and Pinellas County (Clearwater and St. Petersburg), Florida, from 1998 to 2000. Access to and use of community mental health services within 90 days after release from jail was examined, depending on whether persons were enrolled in Medicaid at the time of their release. All analyses were based on detentions, rather than unique persons. The effects of Medicaid status (enrolled or not enrolled) on four dependent variables (probability of use, days to first service, number of services used, and rate of service use) were estimated separately for each county. RESULTS A total of 1,210 persons who had 2,878 detentions were identified in Pinellas County: 2,215 of these detentions represented persons with Medicaid and 663 represented those without Medicaid. For King County, the corresponding numbers were 1,816 persons and 4,482 detentions: 2,752 of these detentions represented persons with Medicaid and 1,730 represented those without Medicaid. In both counties, those who had Medicaid at the time of their release were more likely to use services (p < .001), accessed community services more quickly (p < .001), and received more days of services (p < .001) than those without Medicaid. CONCLUSIONS Medicaid enrollment enhanced receipt of community services after jail release in these two large urban counties. These are the best currently available data, and the data suggest that efforts to enroll persons with severe mental illness in Medicaid and ensure enrollment upon jail release will improve their access to and receipt of community-based services after release.
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Affiliation(s)
- Joseph P Morrissey
- Department of Health Policy and Administration and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7590, USA.
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Morrissey JP, Dalton KM, Steadman HJ, Cuddeback GS, Haynes D, Cuellar A. Assessing gaps between policy and practice in Medicaid disenrollment of jail detainees with severe mental illness. Psychiatr Serv 2006; 57:803-8. [PMID: 16754756 DOI: 10.1176/ps.2006.57.6.803] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This prospective cohort study in two large metropolitan jail systems examined whether Medicaid disenrollment policies for persons detained in jail were enforced. The extent to which persons with severe mental illness lost their Medicaid benefits while detained was determined. METHODS Mailed questionnaires to state Medicaid directors in 2000 yielded a 95 percent response rate. Directors responded to questions about procedures that are followed when enrollees become inmates in public institutions. In addition, community mental health service records, jail detention records, and Medicaid enrollment records were linked in King County (Seattle) and in Pinellas County (Clearwater and St. Petersburg), Florida, to identify persons with severe mental illness who were incarcerated at any time during a two-year period (1996-1998 in King County and 1998-2000 in Pinellas County). The samples consisted of 1,816 persons representing 4,482 detentions in King County and 1,210 persons representing 2,878 detentions in Pinellas County. Detentions were used as the unit of analysis to determine how often Medicaid disenrollment occurred during jail incarceration. RESULTS The stated policy in many states, including Florida and Washington, is to terminate Medicaid benefits upon incarceration, but termination occurred for only 3 percent of the detainees enrolled in Medicaid in each county. In both counties, in 97 percent of the detentions, persons who had Medicaid at entry also had it upon release. In both counties, the 3 percent who lost Medicaid while jailed had longer jail stays (three to five months compared with 16 to 30 days). CONCLUSIONS Stated policies do not align with actual Medicaid disenrollment of persons with severe mental illness who become incarcerated. In most instances, short jail stays allowed detainees with severe mental illness to retain their Medicaid benefits.
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Affiliation(s)
- Joseph P Morrissey
- Department of Health Policy and Administration and with the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7590, USA.
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49
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Cuddeback GS, Orme JG. Training and services for kinship and nonkinship foster families. Child Welfare 2002; 81:879-909. [PMID: 12458778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Researchers have raised concerns about the adequacy of the training and services for foster families in general and kinship families in particular. This study examines the training and services received by kinship and nonkinship family foster caregivers. The article compares kinship and nonkinship caregivers in terms of an array of training and services. The authors examine the demographic characteristics of these two groups and the problems of the foster children placed with them to better understand their needs. Consistent with previous research, levels of training and services received were inadequate for both groups. Contrary to previous research, few differences between kinship and nonkinship caregivers were found in training or services, in demographic characteristics, or in foster children's problems.
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Affiliation(s)
- Gary S Cuddeback
- University of Tennessee, College of Social Work, Children's Mental Health Services Research Center, Knoxville 37996, USA
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