Policy and interventions for adults with SMI and criminal justice involvement

针对 SMI 和刑事司法参与的成年人的政策和干预措施

• 批准号: 8634273
• 负责人: ALLISON R. GILBERT
• 金额: $ 11.42万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-02-15 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8634273
• 关键词: Address; Adjuvant Analgesic; Administrator; Adoption; Adult; Alcohol abuse; Attention; Attitude; Award; Caring; Clinical; Communities; Community Integration; Connecticut; Consumer Preferences; Criminal Justice; Data; Development; Disease; Drug abuse; Effectiveness; Environment; Equilibrium; Evidence based intervention; Evidence based practice; Evidence based treatment; Experimental Designs; Failure; Foundations; Funding; General Population; Goals; Health; Health Personnel; Health Services; Health Services Needs; Healthcare; Hospitals; Human Resources; Imprisonment; Individual; Intervention; Intervention Studies; Interview; Justice; K-Series Research Career Programs; Manuals; Mental Health; Mental Health Services; Mentally Ill Persons; Mentors; Modeling; National Institute of Mental Health; North Carolina; Outcome; Outpatients; Partner in relationship; Penetration; Persons; Pharmaceutical Preparations; Pharmacotherapy; Pilot Projects; Policies; Policy Research; Population; Preparation; Prevalence; Principles of law and justice; Prisons; Professional counselor; Psychiatric Diagnosis; Qualitative Research; Recovery; Research; Research Activity; Research Personnel; Research Project Grants; Research Training; Series; Services; Site; Substance Use Disorder; Substance abuse problem; Survey Methodology; Surveys; System; Testing; Therapeutic; Training; Training Activity; Treatment Protocols; Work; addiction; base; behavioral health; career; career development; community based treatment; community setting; comparative effectiveness; comparison group; cost; criminal offending; effective therapy; evidence base; high risk; implementation research; implementation science; implementation trial; improved; informant; innovation; intervention effect; intervention program; offender; parole; probation; programs; psychosocial; public health relevance; recidivism; reduced substance abuse; research and development; severe mental illness; skills; substance abuse treatment; theories; tool

DESCRIPTION (provided by applicant): The goal of this revised career development proposal is to enable Dr. Allison Robertson to become an independent investigator conducting evidence-based policy and implementation research to improve treatment and reduce recidivism for people with serious mental illness (SMI) and often co-occurring substance use disorders (COD) who are involved in the criminal justice (CJ) system. People with SMI-and especially those with COD-are critically overrepresented in the U.S. CJ system. Many policy and program interventions have been devised over the past 20 years to divert people with SMI away from the CJ system and instead into community-based mental health and substance abuse treatment, all with the hopes of promoting successful community integration and recovery. Evidence for these interventions is promising, but the overall impact has been modest; and substance abuse is a leading predictor of recidivism. Further, little attention has been given to the policy- and practie-level challenges to widespread adoption and implementation of evidence-based interventions for this population. Dr. Robertson aims to focus her future research on identifying effective treatment approaches for persons with SMI and CJ involvement and improving the adoption and implementation of evidence-based policies and practices that can improve health outcomes and reduce recidivism. To that end, she proposes a set of mentored training and research activities in this career development award to develop new skills to pursue her career objectives. Dr. Robertson will develop additional expertise in: (1) understanding of the organization, workforce challenges , and coordination of the public behavioral health and criminal justice systems, with close attention to issues around implementation of evidence-based practices; and (2) implementation science and research, including new training in stakeholder survey methods, some qualitative research training for conducting key-informant interviews, and multi-level modeling for testing intervention effects within and across settings. She will pair mentored training with a set of research projects to study the use of evidence-based substance abuse medications paired with psychosocial treatments-also called medication assisted treatment (MAT)-for treating co-occurring substance abuse among justice-involved people with SMI. Very little is known about the use of MAT among people with COD and justice involvement; yet the evidence base for MAT is strong, and the prospects are substantial for wider use of these treatment regimens to reduce substance abuse, subsequent criminal offending, and promote SMI recovery. In her research projects, Dr. Robertson will (1) use existing merged, administrative data for a population of adults with COD and CJ involvement in Connecticut during 2002-2009 to estimate the effectiveness and penetration rates of MAT as used in conjunction with SMI treatment (versus SMI treatment alone); (2) conduct a two-state survey of relevant stakeholders plus key informant interviews to assess the clinical, systems, and policy considerations for wider adoption and implementation of MAT for use in justice- involved adults with COD; and (3) prepare for a R34 implementation pilot study to improve the use of MAT for this population. R34 development activities will include identifying the appropriate implementation theory to test; designing the experimental intervention for MAT implementation; and early drafting of a manual for an MAT implementation intervention. The training and research proposed herein will build the foundation for the NIMH R34 application during the award period that, itself, will precede a subsequent multi-site implementation trial of MAT for persons with COD who are involved in the CJ system.

描述（由申请人提供）：本修订后的职业发展提案的目标是使 Allison Robertson 博士成为一名独立调查员，开展循证政策和实施研究，以改善严重精神疾病 (SMI) 患者的治疗并减少累犯以及涉及刑事司法 (CJ) 系统的经常同时发生的物质使用障碍 (COD)。患有 SMI 的人，尤其是患有 COD 的人，在美国 CJ 系统中的比例严重过高。过去 20 年来，人们制定了许多政策和计划干预措施，将 SMI 患者从 CJ 系统中转移出来，转而接受基于社区的心理健康和药物滥用治疗，所有这些都是为了促进成功的社区融合和康复。这些干预措施的证据是有希望的，但总体影响不大；药物滥用是累犯的主要预测因素。此外，很少有人关注针对这一人群广泛采用和实施循证干预措施所面临的政策和实践层面的挑战。 Robertson 博士的未来研究重点是为 SMI 和 CJ 患者确定有效的治疗方法，并改进循证政策和实践的采用和实施，以改善健康结果并减少累犯。为此，她在职业发展奖中提出了一系列指导培训和研究活动，以培养新技能来实现她的职业目标。罗伯逊博士将在以下方面发展更多专业知识：（1）了解组织、劳动力挑战以及公共行为健康和刑事司法系统的协调，并密切关注围绕循证实践实施的问题； (2) 实施科学和研究，包括利益相关者调查方法的新培训、进行关键知情人访谈的一些定性研究培训，以及用于测试环境内部和跨环境干预效果的多层次建模。她将指导培训与一系列研究项目结合起来，研究如何使用基于证据的药物滥用药物与心理社会治疗相结合（也称为药物辅助治疗 (MAT)）来治疗 SMI 参与司法的人中同时发生的药物滥用。对于 COD 和司法参与人群中 MAT 的使用情况知之甚少；然而 MAT 的证据基础很强大，并且更广泛地使用这些治疗方案以减少药物滥用、随后的刑事犯罪并促进 SMI 康复的前景广阔。在她的研究项目中，Robertson 博士将 (1) 使用 2002-2009 年康涅狄格州患有 COD 和 CJ 的成年人群的现有合并管理数据来估计 MAT 与 SMI 治疗结合使用的有效性和普及率（与单独 SMI 治疗相比）； (2) 对相关利益相关者进行两国调查以及关键知情人访谈，以评估临床、系统和政策考虑因素，以更广泛地采用和实施 MAT 以用于涉及司法的 COD 成人； (3) 准备 R34 实施试点研究，以改善 MAT 在该人群中的使用。 R34 开发活动将包括确定要测试的适当实施理论；设计 MAT 实施的实验干预；及早起草 MAT 实施干预手册。本文提出的培训和研究将为获奖期间的 NIMH R34 应用奠定基础，该应用本身将先于随后针对参与 CJ 系统的 COD 患者进行 MAT 多地点实施试验。