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

刑事司法系统是美国最大的精神健康提供者，许多司法管辖区 有兴趣减少司法系统在行为健康问题上的使用。这份5年期R01评估 加强倡议是否克服了EBPP实施的障碍及其对关键的影响 结果，如接受行为健康服务的客户数量增加，使用EBPP的人数增加， 和专门的资源，以促进EBPP的使用。这项研究使用了CJ循证机构间 实施模型(CJ-IIM)，并利用定量和定性方法来了解 传播和实施(D/I)变化进程对社区法院扩大使用EBPP产生了积极影响。 鉴于已有455个县同意加入这一进程，现在是一个好时机。机制： 感兴趣的是：1)使用业绩监测和能力来指导系统改革和发展；2)使用 和跨机构团队的运作；3)在支持的机构之间有共同的目标和使命 推动CJS患者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，而不是增加一个计划或培训)。这个 研究将调查455个提升县和455个匹配的配对目标县(每个县4名受访者 包括监狱、缓刑、精神健康服务和药物滥用治疗服务的管理人 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 90名受访者分三波对调查结果进行了背景分析。加强和比较县将 比较目标机制(主要)参与度的变化率和#年的变化率 执行成效成果(次级)，并描述在36个月内开展的改革活动 句号。具体目标是比较提升和比较县：1)目标机制，包括 是否：(A)在假定的目标机制方面，提高县的改善速度更快 第一波和随后的评估(即第二波和第三波)之间的差距；以及(B)这些评估的参与 机制解释在关键执行成果中发现的任何差异；2)检查执行情况 结果，如服务于EBPP的涉及正义的客户数量、行为健康EBPP数量 对涉及司法的个人可用，以及涉及司法的行为健康EBPP的资源 3)说明执行过程和重大事件的特点。我们将使用定性数据来 对量化结果进行三角测量，并丰富对目标机制如何工作和导致 成果，并探索在910个县使用的自然发生的实施战略，从而产生成果。 这项研究将有助于理解系统的决策过程，从而推动D/I科学的发展 在具有不同目标的多个系统中；以及2)D/I努力如何瞄准和推动政策和实践改革。

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.