Gary S. Cuddeback

Foster Parents’ Perceptions of Factors that Promote or Inhibit Successful Fostering:

Foster parents’ perceptions of familial and parental factors that promote or inhibit successful fostering were examined using semi-structured interviews. Characteristics that facilitate successful fostering include faith or support from church, a deep concern for children, tolerance, a strong cooperative marriage in married foster families, and a daily life that is characterized as organized and routinized but flexible in terms of responding to children’s needs and external demands. Characteristics that inhibit successful fostering include non-child-centered fostering motivations, competing demands for parents’ time and energy, parents’ difficulties in dealing with strong attachments to children who might have to leave the family, and personal and interpersonal inflexibility. The findings from this study highlight the need for foster parents to be skilled at creating family patterns that are characterized by clear, consistent routines and expectations as well as flexibility and tolerance. This dialectic pattern of family functioning should be a primary focus during training for foster parent applicants.

Extending Assertive Community Treatment to Criminal Justice Settings: Origins, Current Evidence, and Future Directions

This paper presents an overview of Assertive Community Treatment (ACT) as an evidence-based practice in mental health care. We then consider current evidence for FACT (ACT for forensic populations) and FICM (intensive case management for forensic populations) and the ways these models have been extended and adapted to serve mentally ill persons in a variety of criminal justice settings. The available evidence about the effectiveness of these models towards preventing recidivism among criminally-justice involved persons with mental illness is weak. We conclude with several suggestions for how the clinical model of FACT needs to be expanded to incorporate interventions aimed at reducing criminal behavior and recidivism.

Detecting and Statistically Correcting Sample Selection Bias

ABSTRACT Researchers seldom realize 100% participation for any research study. If participants and non-participants are systematically different, substantive results may be biased in unknown ways, and external or internal validity may be compromised. Typically social work researchers use bivariate tests to detect selection bias (e.g., χ2 to compare the race of participants and non-participants). Occasionally multiple regression methods are used (e.g., logistic regression with participation/non-participation as the dependent variable). Neither of these methods can be used to correct substantive results for selection bias. Sample selection models are a well-developed class of econometric models that can be used to detect and correct for selection bias, but these are rarely used in social work research. Sample selection models can help further social work research by providing researchers with methods of detecting and correcting sample selection bias.

Medicaid Enrollment and Mental Health Service Use Following Release of Jail Detainees With Severe Mental Illness

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.

Assessing gaps between policy and practice in medicaid disenrollment of jail detainees with severe mental illness

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.

Measuring Foster Parent Potential: Casey Foster Parent Inventory-Applicant Version:

Objective: The Casey Foster Applicant Inventory-Applicant Version (CFAI-A) is a new standardized self-report measure designed to assess the potential to foster parent successfully. The CFAI-A is described, and results concerning its psychometric properties are presented. Method: Data from a sample of 304 foster mothers from 35 states are analyzed. Results: Six CFAI-A subscales were identified, and internal consistency reliability for these subscales ranged from .64 to .95. The construct validity of all but one of these subscales is promising. Conclusions: The CFAI-A shows promise for use in research and practice, where it might be used to improve decisions about how to support, monitor, and retain foster families and to match, place, and maintain foster children with foster families.

Fidelity to Recovery-Oriented ACT Practices and Consumer Outcomes

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.

Assessing the Effectiveness of Recovery-Oriented ACT in Reducing State Psychiatric Hospital Use

OBJECTIVE The purpose of this study was to assess the effectiveness of Washington States 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

Challenges to Developing Forensic Assertive Community Treatment

17,000 to

Assertive Community Treatment and the Physical Health Needs of Persons With Severe Mental Illness: Issues Around Integration of Mental Health and Physical Health

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.