Evaluation of Stepping Up Efforts to Improve MH Services and Justice Utilization

对加大力度改善 MH 服务和司法利用的评估

• 批准号: 10677888
• 负责人: JENNIFER E JOHNSON
• 金额: $ 61.78万
• 依托单位: GEORGE MASON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-03 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10677888
• 关键词: Administrator; Adoption; Adult; Agreement; American; Attention; Behavioral Mechanisms; Caring; Charge; Client; Communities; Complex; County; County Government; Criminal Justice; Data; Decision Making; Dedications; Development; Disease; Dissemination and Implementation; Education; Effectiveness; Employment; Environment; Evaluation; Evidence based practice; Foundations; Future; Goals; Health Personnel; Health Services; Health Services Accessibility; Health system; Homelessness; Hospitalization; Imprisonment; Individual; Integrated Health Care Systems; Interview; Investigational Therapies; Jail; Justice; Maintenance; Mental Health; Mental Health Services; Mental disorders; Mentally Ill Persons; Minority; Mission; Modeling; Monitor; Morbidity - disease rate; Outcome; Outcome Measure; Patients; Performance; Persons; Policies; Population; Process; Public Health; Qualitative Methods; Resolution; Resource-limited setting; Resources; Respondent; Screening procedure; State Government; Support System; Surveys; System; Systems Integration; Theoretical Studies; Training; Victimization; Work; behavioral health; design; dissemination science; effectiveness outcome; evidence base; experimental study; health goals; implementation barriers; implementation efforts; implementation outcomes; implementation process; implementation science; implementation strategy; implementation/effectiveness; improved; interest; mortality; parole; peer; physical conditioning; probation; programs; rate of change; skills; substance abuse treatment; substance use; treatment services

The criminal justice system is the largest mental health provider in the U.S., and many jurisdictions are interested in reducing the use of the justice system for behavioral health issues. This 5-year R01 evaluates whether the Stepping Up Initiative overcomes barriers to implementation of EBPPs and the impact on key outcomes, such as increased number of clients receiving behavioral health services, increased use of EBPPs, and dedicated resources to advance the use of EBPPs. The study uses the CJ Evidence-Based Interagency Implementation Model (CJ-IIM) and draws on both quantitative and qualitative methods to understand which dissemination and implementation (D/I) change processes positively impact the expanded use of EBPPs in CJ. Now is an opportune moment, given that 455 counties have agreed to be part of Stepping Up. Mechanisms of interest are: 1) Use of and capacity for performance monitoring to guide system reform and development; 2) Use and functioning of interagency teams; 3) Having common goals and mission across agencies that support system-wide practices to advance the use of behavioral health services for CJS-involved individuals; and, 4) System integration (i.e., building an integrated system of care rather than adding one program or training). The study will survey 455 Stepping Up counties and 455 matched paired target counties (4 respondents per county including administrators of jail, probation, mental health services, and substance abuse treatment services for 3,640 respondents) at three waves: baseline, 18 months, and 36 months. Qualitative interviews will be conducted with 90 respondents at three waves to contextualize survey findings. Stepping Up and comparison counties will be compared on rates of change in engagement of target mechanisms (primary) and rates of change in implementation effectiveness outcomes (secondary) and describe reform activities occurring over a 36-month period. Specific aims are to compare Stepping Up and comparison counties on: 1) Target mechanisms including whether: (a) Stepping Up counties show a faster rate of improvement in hypothesized target mechanisms between Wave 1 and subsequent assessments (i.e., Waves 2 and 3); and (b) whether engagement of these mechanisms explains any differences found in key implementation outcomes; 2) Examine implementation outcomes such as the number of justice-involved clients served with EBPPs, number of behavioral health EBPPs available to justice-involved individuals, and resources for behavioral health EBPPs for justice-involved individuals; and, 3) Characterize implementation processes and critical incidents. We will use qualitative data to triangulate quantitative findings and enrich an understanding of how the target mechanisms work and lead to outcomes, and explore naturally occurring implementation strategies used in 910 counties that lead to outcomes. The study will advance D/I science by contributing to an understanding of 1) systemic decision-making processes in multiple systems with varied goals; and 2) how D/I efforts can target and drive policy and practice reforms.

刑事司法系统是美国最大的心理健康提供者，许多司法管辖区都 有兴趣减少使用司法系统解决行为健康问题。本次5年R01评测 “加强倡议”是否克服了 EBPP 实施的障碍以及对关键领域的影响 结果，例如接受行为健康服务的客户数量增加、EBPP 的使用增加、 并投入专用资源来促进 EBPP 的使用。该研究使用 CJ Evidence-Based Interagency 实施模型 (CJ-IIM) 并利用定量和定性方法来了解哪些 传播和实施 (D/I) 变革流程对 CJ 中 EBPP 的扩大使用产生积极影响。 鉴于 455 个县已同意加入“Stepping Up”计划，现在正是时机。机制 兴趣在于： 1）绩效监控的使用和能力来指导系统改革和发展； 2）使用 以及跨部门团队的运作； 3）支持机构之间有共同的目标和使命 促进 CJS 相关个人使用行为健康服务的全系统做法；以及，4) 系统集成（即建立一个集成的护理系统，而不是添加一个项目或培训）。这 研究将调查 455 个 Stepping Up 县和 455 个匹配的配对目标县（每个县 4 名受访者） 包括监狱、缓刑、精神卫生服务和药物滥用治疗服务的管理人员 3,640 名受访者）分三波：基线、18 个月和 36 个月。将进行定性访谈 与 90 名受访者分三轮进行调查，以了解调查结果。加强和比较县将 比较目标机制（主要）参与度的变化率和 实施有效性结果（次要）并描述 36 个月内发生的改革活动 时期。具体目标是比较 Stepping Up 和比较县： 1) 目标机制，包括 是否： (a) 加强县在假设的目标机制方面表现出更快的改善速度 第一波和后续评估（即第二波和第三波）之间； (b) 是否参与这些 机制解释了关键实施结果中发现的任何差异； 2）检查实施情况 结果，例如接受 EBPP 服务的涉及正义的客户数量、行为健康 EBPP 数量 可供参与司法的个人使用，以及为参与司法的个人提供行为健康 EBPP 资源 个人； 3) 描述实施过程和关键事件的特征。我们将使用定性数据 对定量发现进行三角测量，加深对目标机制如何运作并导致的理解 成果，并探索在 910 个县中自然发生的、可产生成果的实施策略。 该研究将通过促进对 1) 系统决策过程的理解来推进 D/I 科学 在具有不同目标的多个系统中； 2) D/I 工作如何能够瞄准并推动政策和实践改革。

项目成果

The relationship between community public health, behavioral health service accessibility, and mass incarceration.

• DOI: 10.1186/s12913-022-08306-6
• 发表时间: 2022-07-29
• 期刊: BMC health services research
• 影响因子: 2.8

Protocol for a quasi-experimental, 950 county study examining implementation outcomes and mechanisms of Stepping Up, a national policy effort to improve mental health and substance use services for justice-involved individuals.

• DOI: 10.1186/s13012-021-01095-2
• 发表时间: 2021-03-29
• 期刊: Implementation science : IS
• 作者: Johnson JE;Viglione J;Ramezani N;Cuellar AE;Hailemariam M;Rosen R;Breno A;Taxman FS
• 通讯作者: Taxman FS

Multilevel Matching in Natural Experimental Studies: Application to Stepping up Counties.

自然实验研究中的多级匹配：在县级升级中的应用。

• 发表时间: 2020
• 期刊: Proceedings. American Statistical Association. Annual Meeting
• 作者: Ramezani,Niloofar;Breno,Alex;Viglione,Jill;Mackey,Benjamin;Cuellar,AlisonEvans;Chase,April;Johnson,Jennifer;Taxman,Faye
• 通讯作者: Taxman,Faye