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: 10006901
• 负责人: JENNIFER E JOHNSON
• 金额: $ 67.3万
• 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/10006901
• 关键词: Administrator; Adoption; Adult; Alcohol or Other Drugs use; American; Attention; Behavioral Mechanisms; Caring; Centers for Disease Control and Prevention (U.S.); Charge; Client; Communities; Complex; County; County Government; Criminal Justice; Data; Decision Making; Development; Disease; Education; Effectiveness; Employment; Environment; Evaluation; Evidence based practice; Face; Foundations; Future; Goals; Health Personnel; Health Services; Health Services Accessibility; Health system; Homelessness; Hospitalization; Imprisonment; Individual; Interview; Investigational Therapies; Jail; Justice; Lead; Maintenance; Measurable; Mental Health; Mental Health Services; Mental disorders; Mentally Ill Persons; Minority; Mission; Modeling; Monitor; Morbidity - disease rate; Outcome; Patients; Performance; Policies; Population; Process; Public Health; Qualitative Methods; Resolution; Resources; Respondent; Screening procedure; State Government; Support System; Surveys; System; Systems Integration; Theoretical Studies; Training; Victimization; Work; behavioral health; care systems; design; evidence base; experimental study; health goals; implementation science; implementation strategy; improved; interest; parole; peer; physical conditioning; probation; programs; rate of change; skills; substance abuse treatment; treatment services; Administrator; Adoption; Adult; Alcohol or Other Drugs use; American; Attention; Behavioral Mechanisms; Caring; Centers for Disease Control and Prevention (U.S.); Charge; Client; Communities; Complex; County; County Government; Criminal Justice; Data; Decision Making; Development; Disease; Education; Effectiveness; Employment; Environment; Evaluation; Evidence based practice; Face; Foundations; Future; Goals; Health Personnel; Health Services; Health Services Accessibility; Health system; Homelessness; Hospitalization; Imprisonment; Individual; Interview; Investigational Therapies; Jail; Justice; Lead; Maintenance; Measurable; Mental Health; Mental Health Services; Mental disorders; Mentally Ill Persons; Minority; Mission; Modeling; Monitor; Morbidity - disease rate; Outcome; Patients; Performance; Policies; Population; Process; Public Health; Qualitative Methods; Resolution; Resources; Respondent; Screening procedure; State Government; Support System; Surveys; System; Systems Integration; Theoretical Studies; Training; Victimization; Work; behavioral health; care systems; design; evidence base; experimental study; health goals; implementation science; implementation strategy; improved; interest; parole; peer; physical conditioning; probation; programs; rate of change; skills; substance abuse treatment; 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，许多司法管辖区是 有兴趣减少对行为健康问题的使用。这个5年R01评估 是否加紧倡议克服了实施EBPP的障碍以及对密钥的影响 结果，例如增加了行为健康服务的客户数量，增加了EBPP的使用， 和专门的资源来推动EBPP的使用。该研究使用CJ基于证据的机构 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）更改过程对CJ中EBPP的扩大使用的扩大使用。 鉴于有455个县同意成为加紧的一部分，现在是一个合适的时刻。机制 兴趣是：1）使用和绩效监控能力指导系统改革和开发； 2）使用 和机构间团队的运作； 3）在支持支持的机构中拥有共同的目标和使命 为了推动针对CJS的个人使用行为健康服务的系统范围的实践；而且，4） 系统集成（即建立一个集成的护理系统，而不是添加一个程序或培训）。这 研究将调查455个加紧县和455个匹配的成对目标县（每个县4个受访者 包括监狱管理员，缓刑，心理健康服务和药物滥用治疗服务 3,640名受访者）在三波中：基线，18个月和36个月。定性访谈将进行 有90名受访者在三波中，以将调查结果进行环境化。加紧，比较县将 比较目标机制的参与度变化率（主要） 实施有效性结果（次要）并描述了36个月以来发生的改革活动 时期。具体目的是比较加紧和比较县：1）包括 是否：（a）加紧县显示出假设的目标机制的提高速度更快 在波浪1和随后的评估之间（即波2和3）； （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 诸如与EBPP的司法客户的数量，行为健康EBPP的数量之类的结果 可用于司法人员的个人，以及用于正义的行为健康EBPP的资源 个人3）表征实施过程和关键事件。我们将使用定性数据 三角定量发现，并丰富了对目标机制如何工作的理解并导致 结果，并探索910个县中使用的自然实施策略，从而导致结果。 这项研究将通过理解1）系统性决策过程来提高D/I科学 在多个目标的系统中； 2）D/I努力如何针对和推动政策和实践改革。