Hsiu-Ju Lin

Outcomes of Trauma Treatment Using the TARGET Model

ABSTRACT In a randomized trial of a group intervention for co-occurring substance abuse and traumatic stress disorders “Trauma Adaptive Recovery Group Education and Therapy” (TARGET) was compared to trauma-sensitive usual care (TSU) with 213 clients in three adult outpatient clinics. Improvement at 6- and 12-month assessments occurred across conditions. TARGET was superior to TSU in maintaining sobriety self-efficacy. However, ethnic differences emerged. White TARGET participants reported more improvement than non-White participants on post-traumatic cognitions, and fewer non-White men reported relapses in TSU than in TARGET. TARGET appears to enhance sustained sobriety, but may require culturally specific adaptations.

Ethnic differences in the effects of spiritual well-being on long-term psychological and behavioral outcomes within a sample of homeless women.

The present study examines ethnicity as a moderator variable between spiritual well-being (SWB) and psychological and behavioral outcomes. Participants included in this analysis were 88 African American (46.6%) and 101 non-African American (total N = 189) homeless mothers. Through structured interviews conducted at 3-month intervals over a period of 15 months, data were collected on spiritual well-being, mental health, trauma symptoms, substance use, parenting, and child behavior. Hierarchical linear model and general estimating equation results indicated that ethnicity moderates the relationship between SWB and anxiety, trauma symptoms, child behavior, and parenting outcomes. On average, African Americans reported significantly higher SWB than non-African Americans, indicating the relative importance of spirituality in their lives. These findings support previous research indicating a difference in the role that SWB plays in the lives of African Americans compared to non-African Americans.

Costs of criminal justice involvement among persons with serious mental illness in connecticut.

OBJECTIVE This study sought to describe patterns and costs of criminal justice involvement among adults with serious mental illness who received services across public agencies within a single state. Costs were examined from the perspective of state agencies providing mental health, substance abuse, and criminal justice services. METHODS Administrative records for 25,133 adults who were served by the Connecticut Department of Mental Health and Addiction Services (DMHAS) during fiscal years 2006 and 2007 and who had a diagnosis of schizophrenia or bipolar disorder were matched with records of the state Medicaid program, Judicial Branch, Department of Correction, and Department of Public Safety. Unit costs for service events were combined with utilization data to calculate costs per person. RESULTS About one in four individuals was involved with the justice system during the two-year period. The justice-involved group incurred costs approximately double those of the group with no involvement-

Outcomes of Court-Based Jail Diversion Programs for People with Co-Occurring Disorders

48,980 compared with

Use of integrated dual disorder treatment via assertive community treatment versus clinical case management for persons with co-occurring disorders and antisocial personality disorder.

24,728 per person. Costs were shared by several state agencies and Medicaid. DMHAS bore the largest proportion of state service costs, covering 49% of total costs for persons with justice involvement and 69% of costs for those without involvement. CONCLUSIONS Criminal justice involvement is a complex and costly problem that affects a substantial proportion of adults with serious mental illness who receive services across state agencies. Applying per-person cost estimates in other states could help mental health and criminal justice systems to better plan, coordinate, and deliver cost-effective services to individuals with serious mental illness who become involved with the criminal justice system.

Applying classification and regression tree analysis to identify prisoners with high HIV risk behaviors

ABSTRACT Objectives: Incarceration is widely believed to be unnecessary and harmful for criminal defendants with psychiatric disorders, most of whom have co-occurring substance use problems. An increasingly popular approach for such defendants is diversion away from the criminal justice system and into treatment. In this article, we present the findings of a quasi-experimental study evaluating the post-booking, arraignment court-based model of diversion used in Connecticut. To improve upon previous quasi-experimental studies, we employ propensity scoring to compare similar defendants from courts with diversion and with no diversion programs. Methods: Persons with serious mental illness and co-occurring substance use disorders were recruited into the study from among criminal defendants in seven criminal courts with diversion programs (n = 113) and five courts without diversion programs (n = 98). Structured research interviews, including measures of mental health, substance use, criminal involvement, employment, and quality of life, were conducted at baseline and at 3 and 12 months following baseline. Additional data was collected from administrative sources in the correctional department and court system. Results: The most striking differences between the diversion and the comparison groups were that the diversion group spent significantly fewer days incarcerated in the year following the index arrest, and were also less likely to be re-incarcerated. Grouping by time differences also suggests greater improvements in life satisfaction favoring the diversion group. Conclusions: Post-booking diversion programs can successfully divert individuals with co-morbid psychiatric and substance use without increased risk to the individual or the community, and with modest improvements in life satisfaction for the defendant.

When goals diverge: Staff consensus and the organizational climate

We conducted secondary analyses of data from a randomized trial testing the effectiveness of Assertive Community Treatment (ACT) in delivery of integrated dual disorder treatment (IDDT) to explore the impact of IDDT delivered through ACT teams compared with standard clinical case management for dually-disordered persons with and without antisocial personality disorder (ASPD). This analysis included 36 individuals with ASPD and 88 individuals without ASPD. Participants with ASPD assigned to ACT showed a significantly greater reduction in alcohol use and were less likely to go to jail than those in standard clinical case management, whereas participants without ASPD did not differ between the 2 case management approaches. There were no significant differences for other substance use or criminal justice outcomes. This study provides preliminary evidence that persons with co-occurring serious mental illness, substance use disorders, and ASPD may benefit from delivery of IDDT through ACT teams.

Influence of Criminal Justice Involvement and Psychiatric Diagnoses on Treatment Costs Among Adults With Serious Mental Illness

Abstract Among prisoners, past research has associated several factors with HIV risk behaviors, including illicit drug use, engaging in sex trade, older age (for drug-related risk), younger age (for sexrelated risk), low education, low income, type of offense, history of abuse, mental health disorders, vulnerability and low self-perceived efficacy. This study employs data collected through the Transitional Case Management study of the Criminal Justice Drug Abuse Treatment Studies collaborative to analyze characteristics of prisoners who engaged in high-risk behaviors prior to incarceration. For the first 787 participants of this study, we employed recursive partitioning techniques to better identify groups at varying levels of HIV risk behaviors. Those more likely to engage in risky needle use were White and either unemployed and less likely to justify their behavior, or employed with poor decision making capacity. Risky sexual behavior was associated with a general tendency toward risk-taking or a history of unstable housing. Those engaging in any type of HIV risk behavior were risk-takers in general and were aged 25 to 47 with a history of unstable housing. Recursive partitioning, a technique seldom used previously, offers a useful method for identifying subpopulations at elevated risk for HIV risk behaviors.

Associations between pharmacotherapy for opioid dependence and clinical and criminal justice outcomes among adults with co-occurring serious mental illness ☆

A sample of correctional officers and prison substance abuse treatment staff collected by the National Criminal Justice Treatment Practices Survey is used to provide an exploratory study of an aspect of organizational culture consisting of consensus (agreement) among prison personnel regarding their beliefs about rehabilitation in the presence of conflicting organizational goals and aspects of the organizational climate important to change. Findings show that among those staff members responding to the survey, the belief in rehabilitation scale mean score was associated with higher levels of organizational commitment, and interdepartmental coordination. However, an hierarchical linear modeling (HLM) analysis that used an index score derived from the standard deviation for staff consensus regarding these same beliefs about rehabilitation produced a different pattern of results, showing that high levels of consensus were associated with job frustration, cynicism towards the ability of the institution to change, and lower levels of organizational commitment. The authors conclude that, although the sample may not express the beliefs of corrections officers or prison-based treatment staff at large, within the sample, consensus appeared to play a unique role in evaluating the effect of divergent goals on organizational climate as it relates to change, and warrants consideration when considering the effects of organizational climate.

Effects of a strategy to improve offender assessment practices: staff perceptions of implementation outcomes

The impact of criminal justice involvement and clinical characteristics on the cost of public treatment services for adults with serious mental illnesses is unknown. The authors examined differential effects of justice involvement on behavioral health treatment costs by primary psychiatric diagnosis (schizophrenia or bipolar disorder) and also by substance use diagnosis among 25,133 adult clients of Connecticuts public behavioral health system in fiscal years 2006 and 2007. Justice-involved adults with schizophrenia had the highest costs, strongly driven by forensic hospitalizations. Addressing the cross-system burdens of forensic hospitalizations may be a sensible starting point in the effort to reduce costs in both the public behavioral health and justice systems.