Policy and interventions for adults with SMI and criminal justice involvement

描述(由申请人提供)：这项修订后的职业发展提案的目标是使Allison Robertson博士能够成为一名独立调查员，进行循证政策和执行研究，以改善严重精神疾病(SMI)和经常同时发生的物质使用障碍(COD)患者的治疗并减少再犯罪率，这些患者涉及刑事司法(CJ)系统。患有SMI的人--尤其是那些患有COD的人--在美国CJ系统中的比例严重偏高。在过去的20年里，制定了许多政策和计划干预措施，将SMI患者从CJ系统转移到基于社区的精神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；药物滥用是再次犯罪的主要预测因素。此外，对广泛采用和实施针对这一人群的循证干预措施所面临的政策和实践层面的挑战几乎没有给予关注。Robertson博士的目标是将她未来的研究重点放在为参与SMI和CJ的人寻找有效的治疗方法，并改进循证政策和实践的采用和实施，以改善健康结果和减少再犯罪率。为此，她在这个职业发展奖中提出了一套有指导的培训和研究活动，以发展新的技能来追求她的职业目标。Robertson博士将在以下方面培养更多的专业知识：(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，并密切关注循证实践的实施问题；(2)实施科学和研究，包括利益相关者调查方法的新培训，用于进行关键信息提供人访谈的一些定性研究培训，以及用于在环境内和跨环境测试干预效果的多层次建模。她将把有指导的培训与一系列研究项目结合起来，研究以证据为基础的药物滥用药物与心理社会治疗-也称为药物辅助治疗(MAT)-的使用，以治疗涉及正义的SMI患者中共同发生的药物滥用。在涉及药物滥用和司法的人群中，人们对MAT的使用知之甚少；然而，MAT的证据基础很强，而且更广泛地使用这些治疗方案以减少药物滥用、随后的犯罪行为和促进SMI恢复的前景是巨大的。在她的研究项目中，Robertson博士将(1)使用2002-2009年康涅狄格州涉及COD和CJ的成年人群的现有合并管理数据，以评估MAT与SMI治疗(与SMI单独治疗相比)的有效性和渗透率；(2)对相关利益相关者进行一项两州调查，并对关键信息者进行访谈，以评估更广泛地采用和实施MAT用于涉及司法的成人COD的临床、系统和政策考虑；以及(3)准备进行R34实施的试点研究，以改进MAT在这一人群中的使用。R34发展活动将包括确定适当的实施理论以进行测试；为MAT实施设计实验干预措施；以及及早起草一份MAT实施干预手册。本文提出的培训和研究将为NIMH R34在授权期内的应用奠定基础，而授权期本身将先于随后为参与CJ系统的COD患者进行的MAT多站点实施试验。

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.