Roger A. Boothroyd

Perceived coercion and procedural justice in the Broward mental health court.

Approximately 700,000 people with major mental disorder enter United States jails each year (U.S. Department of Justice, 1999), many of whom are arrested repeatedly for minor felonies and misdemeanors. It is increasingly assumed that their mental disorder and attendant difficulties accessing clinical services and social support programs contribute to this pattern of repeated contact with the criminal justice system. This in turn frustrates the efficiency concerns of the criminal justice system because of the extensive resources consumed by repeatedly booking, jailing, and attempting to treat these individuals in the jail setting. It also frustrates therapeutic objectives because these individuals may become increasingly distant and disengaged from their families and from community-based mental health services. The most recent innovation to address this problem has come in the form of specialty courts called mental health courts. Based somewhat on the drug court model, mental health courts vary in terms of point of intervention (e.g., preversus postadjudication), eligibility requirements (most are limited people with mental illness charged with nonviolent misdemeanors), the use of sanctions, and in other particulars (see Goldkamp & Irons-Guynn, 2000). However, all appear to have as a primary goal interrupting the cycle of repeat offending and incarceration through the expeditious processing of defendants with mental illness, providing access to treatment and social supports, and assuring public safety (Lerner-Wren, 2000). To date no mental health court has been evaluated systematically to determine its efficacy and outcomes. We are currently involved in a 2-year evaluation of the Broward County

The Broward Mental Health Court: process, outcomes, and service utilization

Mental health courts are one of a variety of special jurisdiction courts that have been created in a number of countries, including the United States (Petrila, 2003). While there is no prototypical mental health court (Steadman, Davidson, & Brown, 2001; Watson, Luchins, & Hanrahan, 2001), most of those in existence today share several common characteristics. These include (a) the creation of a special docket (usually, but not always, nonviolent misdemeanants with mental illness) that is (b) handled by a particular judge, with (c) a primary goal of diverting defendants from the criminal justice system and into treatment (Goldkamp & Irons-Guynn, 2000). In addition, the principle of therapeutic jurisprudence has been influential as a philosophic basis for the creation of some if not all mental health courts. ‘‘Therapeutic jurisprudence’’ has been offered as a way for courts and attorneys to examine ‘‘the extent to which substantive rules, legal procedures, and the roles of lawyers and judges produce therapeutic or antitherapeutic consequences’’ (Wexler & Winick, 1991). Both mental health court (Wren, 1998) and drug court judges (Hora, Schma, & Rosenthal, 1999) have been explicit in their reliance on therapeutic jurisprudence as the underpinning of their courts. We are currently evaluating the Broward County Florida Mental Health Court (MHC), one of the first mental health courts in the United States. Full details of this evaluation are

A framework for evaluating systems thinking interventions: an experimental approach to mental health system change

Researchers from the State University of New York at Albany and the New York State Office of Mental Health have been engaged in testing an experimental approach to evaluating systems thinking interventions. This research calls for a similar systems thinking intervention to be repeated in four counties with four control counties also selected and observed via pre- and post-intervention measures. The overall context of the project focuses on integration of mental health and vocational rehabilitation services. The experiment is designed to evaluate measurable outcomes, including shifts in goal structures and change strategies of the management team, shifts in relative alignment of the management team as a whole, perceived success of the intervention, and changes in systems and procedures necessary to improve client services. This article presents a framework for evaluating systems thinking interventions as well as preliminary findings from the pilot test.

An experimental study of the effectiveness of intensive in-home crisis services for children and their families: Program outcomes.

In this article, we describe the outcomes associated with a 3-year research demonstration project. It is the second of a two-part article concerned with this research conducted in the Bronx, New York, to examine the efficacy of three models of intensive in-home services—Home-Based Crisis Intervention (HBCI), Enhanced Home-Based Crisis Intervention (HBCI+),and Crisis Case Management—as alternatives to hospitalization for children experiencing a psychiatric crisis. In Part I (Evans, Boothroyd, & Armstrong, 1997), we described the features of the three program models, the research design, data collection measures, and the presenting characteristics of the children and families. In Part 2, we describe the success of maintaining children at home (82%) and the increases in family adaptability, childrens self-concept, and parental self-efficacy both at discharge and at 6 months postdischarge. Enrollees in two of the models (HBCI and HBCI+) experienced a significant increase in family cohesion,although this was not maintained at 6 months postdischarge. While enrollees in the enhanced program showed significant increase in social support at discharge, all enrollees experienced this at 6 months postdischarge.

Development and Implementation of an Experimental Study of the Effectiveness of Intensive In-Home Crisis Services for Children and Their Families.

This article describes a 3-year research demonstration project originally funded by the National Institute of Mental Health and now funded in part by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. This project, which was conducted in the Bronx, New York, examined the efficacy of 3 models of intensive in-home services as alternatives to hospitalization for children experiencing serious psychiatric crises. All programs were 4- to 6-week interventions. The first, Home-Based Crisis Intervention (HBCI), was modeled on the Homebuilders model of family preservation; the second, Enhanced HBCI (HBCI+), added respite care, flexible service money, parent advocate and support services, and additional staff training in cultural competence and violence management. Crisis Case Management, the third model, used case managers to assess child and family needs and link them to services, as well as respite care and flexible money. The specific features of the 3 program models, the research design, and data collection measures are described. The intake data on the children and families are presented, and implications for providing services and for future research are discussed.

Lessons from the Broward County Mental Health Court Evaluation

The creation of specialty mental health courts has emerged as a strategy to address the impact of persons with mental illness in the criminal justice system by consolidating the management of certain types of cases into a single court. This article describes an evaluation of the nations first such court, the Broward County Mental Health Court. The purpose is to alert those who may conduct future evaluations of these types of courts to some of the contextual, logistic, and management features of our evaluation and the challenges we have encountered doing field research in this unique legal setting.

Leaving the Welfare Rolls: The Health and Mental Health Status of Current and Former Welfare Recipients

This paper summarizes the mail survey findings of 1,634 respondents examining the impact of welfare reform, namely the Work and Gain Economic Self Sufficiency (WAGES) program, in two urban areas of Florida. The health and mental health status, quality of life, and service needs of adults and children who had left WAGES were compared with those of current recipients. Findings indicate that 60% of the respondents had left WAGES during a 14-month period. Compared to former WAGES recipients, current recipients reported significantly poorer health and mental health status. Additionally, the children of current recipients had significantly greater health needs compared to those of former WAGES recipients. Although no group difference existed regarding the childrens mental health status, the percentage of children scoring above the criterion suggesting a need for further psychosocial evaluation was twice the rate that would be expected in a general pediatric sample. Transportation was the only service need in which a significant group difference was found, with current recipients reporting significantly greater need compared to former recipients. Compared to former WAGES recipients, current recipients reported significantly lower levels of satisfaction with their leisure opportunities, employment or educational status, financial condition, legal and safety, familys health, and with their overall quality of their lives.

The Impact of Research Participation on Adults with Severe Mental Illness

Experiences of adults with mental illness who participated in a 12-month managed care study are summarized. During exit interviews, participants were asked about consent procedures, study purpose, if questions were intrusive or anxiety producing, and concerns about information disclosure. Respondents rated their experience and likelihood of future participation. Almost 38% did not remember the consent procedures. Among those who did, 22.4% reported they lacked adequate detail about the scope of the study. Nearly 3% felt pressured into participating. Although most participants (96%) reported positive experiences, 8.8% became anxious, 16.8% were afraid responses would be disclosed, and 16.7% indicated questions were invasive. Age, race/ethnicity, and gender were not associated with adverse reactions. Symptomatology and perceived inadequacies in consent procedures were significantly, albeit weakly, associated with adverse reactions. Although most participants experienced no distress, rates of adverse responses among persons with mental illness exceeded those of community-based samples. Strategies for minimizing negative reactions are discussed.

Adherence to practice guidelines, clinical outcomes, and costs among Medicaid enrollees with severe mental illnesses.

The treatment of Medicaid enrollees diagnosed with depression or schizophrenia was examined to determine whether adherence to treatment guideline was associated with health care financing strategy, clinical outcomes, and cost-effectiveness. Individuals in a fee-for-service condition were significantly more likely to receive treatment consistent with guidelines than those in managed care. Mental health costs were higher for individuals diagnosed with schizophrenia, individuals in an acute phase of illness at intake into the study, and those receiving treatment consistent with practice guidelines. Being in an acute phase of illness and having treatment that comported with recommended practice guidelines were associated with higher total social costs. Policy implications of the findings and recommendations for future research are discussed.

Conducting research in culturally diverse inner-city neighborhoods: some lessons learned.

Social, behavioral, and health research among disenfranchised groups in inner cities poses problems in collecting data. It is a challenge to achieve data of sufficient quantity and quality necessary to be scientifically usable. This article describes the experiences of a research team during two phases of data collection in a mental health intervention study in New York’s South Bronx. Challenges in addressing human subject concerns, the formation of a fieldwork team, enrollment and retention of respondents, and administration of instruments are described and solutions are discussed. Emphasis is placed on researchers’ approaches to the selection, orientation, and safety of interviewers, interviewer-respondent race and ethnic matching, contacts and rapport with respondents, and the handling of such interpersonal issues as distrust, poor cooperation, and family dynamics. The procedures developed took into consideration the culture and life conditions of the population to ensure a satisfactory response rate and high-quality data.