Community Reentry of Persons with Severe Mental Illness Released from State Priso

描述（由申请人提供）：项目摘要/摘要精神病患者参与刑事司法系统代表了社区精神健康和残疾研究的新前沿。这一问题的范围确实令人震惊，每年有超过86，000名患有严重精神疾病的人从监狱释放，累犯率很高。被监禁的罪犯失去医疗补助金被认为是成功重返社区的主要障碍。几个州已经采取了加快医疗补助恢复计划，以重新连接合格的囚犯，他们的福利之前释放。早期恢复福利可以避免在重度精神障碍罪犯被释放到社区时中断他们的药物治疗方案和治疗。然而，没有进行严格的研究来确定这些政策的成本效益。建议响应RFA-MH-09-050从NIMH与一项为期三年的研究，解决这些问题，通过评估医疗补助恢复政策在康涅狄格州和华盛顿州的释放囚犯谁有SMI关于三个结果，随后的累犯，住院治疗，门诊心理健康和药物滥用服务的使用。将实施两项互补的研究设计和分析方法，以探讨这些政策的影响（目标1）和成本效益（目标2）。第一个是一个差异中的差异设计比较个人与SMI和那些没有SMI集中在政策采用日期为2005年4月1日在康涅狄格州和2006年1月1日在华盛顿与三年前和两年后的数据在每个国家。第二个是一个准实验研究设计，专注于后期只比较个人与SMI谁接受了加速医疗补助恢复（治疗组）与那些谁没有（对照组）超过两年的随访期使用分层线性模型框架。倾向评分匹配将用于两种设计，以在所有观察指标上实现组间平衡。拟议的研究与RFA-MH-09-050保持一致，因为它解决了州当局的一个重要的心理健康政策问题，利用了来自两个州的大量行政数据，应用了一系列经济学和统计学领域的分析策略来解决一个重要的州心理健康政策问题，并回应了总统精神健康新自由委员会（2002年）提出的对严重精神疾病患者进行司法相关研究的呼吁。 公共卫生相关性：美国各地的精神病罪犯正在返回他们的家乡社区。研究需要确定他们的需要，以及他们如何能够成功地重新融入社区生活，而不需要进一步的刑事司法参与。这项建议是针对这一重大公共卫生问题提出的。

DESCRIPTION (provided by applicant): Project Summary/Abstract Mentally ill persons involved in the criminal justice system represent the new frontier for community mental health and disability research. The scope of this problem is truly staggering with upwards of 86,000 persons with severe mental illness (SMI) released from prisons each year with high rates of recidivism. The loss of Medicaid benefits by incarcerated offenders is thought to be a major obstacle to successful community reentry. Several states have adopted expedited Medicaid restoration programs to reconnect eligible prisoners to their benefits prior to release. Early benefit restoration can avoid disruptions in medication regimens and treatments for offenders with SMI when they are released to the community. However, no rigorous research has been conducted to establish the cost-effectiveness of these policies. The proposed responds to with RFA-MH-09-050 from the NIMH with a three-year study that addresses these concerns by undertaking an assessment of Medicaid restoration policies in Connecticut and Washington State for released prisoners who have SMI with regard to three outcomes-subsequent recidivism, hospitalizations, and outpatient mental health and substance abuse service use. Two complementary study designs and analytic approaches will be implemented to address the impact (Aim 1) and cost-effectiveness (Aim 2) of these policies. The first is a difference-in-difference design comparing individuals with SMI and those without SMI centered on a policy adoption date of April 1, 2005 in Connecticut and January 1, 2006 in Washington with three years pre and two years post data in each state. The second is a quasi-experimental study design focused on the post-period only comparing individuals with SMI who received expedited Medicaid restoration (treatment group) vs. those who did not (comparison group) over a two-year follow-up period using a hierarchical linear modeling framework. Propensity score matching will be used with both designs to achieve balance between groups on all observed measures. The proposed study is well-aligned with RFA-MH-09-050 in that it addresses an important mental health policy issue for state authorities, takes advantage of a wealth of administrative data from two states, applies an array of analytical strategies from the fields of economics and statistics to address an important state mental health policy issue, and responds to the call for research about justice-involved persons with severe mental illness as put forth in the President's New Freedom Commission on Mental Health (2002). PUBLIC HEALTH RELEVANCE: All across the US mentally ill offenders are returning to their home communities. Research needs to identify their needs and how they can successfully reintegrated into community life without further criminal justice involvements. This proposal is addressed to this major public health problem.