The Jail-to-Homelessness Pipeline and Serious Mental Illness

监狱到无家可归者的管道和严重的精神疾病

• 批准号: 10650336
• 负责人: Enrico Guanzon Castillo
• 金额: $ 19.72万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10650336
• 关键词: Address; Administrator; Area; Collaborations; Country; County; Criminal Justice; Data; Data Set; Development; Discharge Plannings; Elements; Ensure; Ethnography; Failure; Future; Goals; Health; Health Planning; Health Resources; Health Services; Health Services Research; Health system; Health trends; Healthcare; Homeless persons; Homelessness; Hospitalization; Hospitals; Housing; Imprisonment; Individual; Inequity; Institution; Institutional Policy; Intervention; Intervention Studies; Jail; Justice; Knowledge; Laws; Link; Los Angeles; Mental Health; Mental Health Services; Mental disorders; Mentors; Methods; Modeling; National Institute of Mental Health; Outcome; Pattern; Persons; Policies; Policy Maker; Population; Prisoner; Prisons; Public Health; Public Sector; Qualitative Research; Quality of Care; Research; Research Activity; Research Methodology; Research Personnel; Research Project Grants; Research Support; Resource Allocation; Resources; Risk; Safety; Service delivery model; Services; Site; Social Work; Social outcome; Subgroup; System; Testing; Translations; Vulnerable Populations; administrative database; care coordination; care systems; career; career development; cost; data infrastructure; delivery vehicle; design; evidence base; experience; health care service; health inequalities; health service use; high risk; improved; innovation; medically underserved; mental representation; prevent; programs; psychological distress; recidivism; reincarceration; severe mental illness; skills; social; therapy design; trend; underserved community

PROJECT SUMMARY / ABSTRACT This career development proposal will support Dr. Enrico Castillo to become an independent researcher focused on serious mental illness (SMI), incarceration, homelessness, and public mental health systems, with expertise in conducting mixed methods studies to improve the capacity of public systems to eradicate the health and social inequities experienced by individuals with SMI. People with SMI experience severe inequities, which are particularly evident within homeless populations and correctional facilities where people with SMI are grossly overrepresented. These national challenges are reflected in Los Angeles County, which has the largest unsheltered population of people with SMI in the US. The Los Angeles County jail is the largest facility in the world for the confinement of people with SMI. In the face of scarce public mental health resources and concentrations of people with mental illness in jails, some have posited that jails may serve important public health functions and have positive mental health effects on individuals with SMI. This raises important scientific questions. Dr. Castillo plans to focus his research on understanding the unmet health and social needs of individuals with SMI by studying the effects of incarceration on subsequent health and social trajectories—the jail-to-homelessness pipeline. Dr. Castillo’s proposal centers on mentored career development and research activities that will develop the skills to achieve these career goals: 1) quantitative analysis of linked administrative data, 2) qualitative research methods, specifically ethnography, archival research, and mixed methods dialogue, 3) criminal justice systems and vulnerable justice-involved populations, and 4) dissemination and translation of health services research findings to policy and practice. Given the challenges of studying individuals after jail release, relatively less is known about the precise relationship between incarceration and subsequent homelessness and its downstream effects on healthcare and social trajectories for people with SMI. Fragmented systems of care and siloed data infrastructures are additional barriers to research, coordination of care, allocation of resources, and public health planning. To address these lacunae, Dr. Castillo’s research project will 1) use an existing linked administrative database of eight public service agencies in Los Angeles County to understand whether jail is disruptive to mental health and social service use and housing stability for people with SMI; 2) conduct archival research and direct ethnographic observations in the Los Angeles County jail to elucidate the jail experiences and services and ascertain the mechanisms underlying post-incarceration trajectories; and 3) prepare for a R01 health services research grant (PAR-17-264). Building on this project’s findings about factors that lead to post-incarceration homelessness, that future multi-site R01 will employ the same mixed methods to investigate the full circuit of institutional recidivism (reincarceration, hospitalization, homelessness), to identify the public service use trajectories, programs, and other mutable factors (individual- to system-level) that prevent or disrupt those outcomes.

项目概要/摘要 该职业发展提案将支持 Enrico Castillo 博士成为一名独立研究员 重点关注严重精神疾病 (SMI)、监禁、无家可归和公共精神卫生系统， 开展混合方法研究的专业知识，以提高公共系统根除艾滋病毒的能力 SMI 患者所经历的健康和社会不平等。患有 SMI 的人会经历严重的 不平等现象在无家可归者和人们所在的惩教设施中尤为明显 SMI 的比例严重过高。这些全国性的挑战反映在洛杉矶县， 拥有美国最多的无庇护 SMI 患者。洛杉矶县监狱是最大的 世界上用于限制 SMI 患者的设施。面对稀缺的公共卫生资源 以及精神病患者集中在监狱中，一些人认为监狱可能发挥重要作用 公共卫生功能并对 SMI 患者产生积极的心理健康影响。这引发了重要 科学问题。卡斯蒂略博士计划将他的研究重点放在了解未满足的健康和社会问题上 通过研究监禁对后续健康和社会的影响来满足 SMI 患者的需求 轨迹——从监狱到无家可归者的管道。卡斯蒂略博士的提案以受指导的职业为中心 开发和研究活动将培养实现这些职业目标的技能：1）定量 相关行政数据的分析，2）定性研究方法，特别是民族志、档案 研究和混合方法对话，3) 刑事司法系统和司法相关弱势群体， 4) 将卫生服务研究成果传播并转化为政策和实践。鉴于 研究出狱后的个人面临的挑战，对确切关系的了解相对较少 监禁和随后的无家可归之间及其对医疗保健和社会的下游影响 SMI 患者的轨迹。分散的护理系统和孤立的数据基础设施是额外的问题 研究、护理协调、资源分配和公共卫生规划方面的障碍。为了解决这些 尽管存在缺陷，Castillo 博士的研究项目将 1) 使用现有的八个公共管理链接数据库 洛杉矶县的服务机构了解监狱是否会破坏心理健康和社交 SMI 患者的服务使用和住房稳定性； 2）进行档案研究和直接民族志研究 在洛杉矶县监狱进行的观察，以阐明监狱的经验和服务并确定 监禁后轨迹的机制； 3) 准备 R01 健康服务研究补助金 （PAR-17-264）。根据该项目关于导致监禁后无家可归的因素的调查结果， 未来的多站点R01将采用相同的混合方法来调查机构的全电路 累犯（重新监禁、住院、无家可归），以确定公共服务的使用轨迹， 计划和其他可变因素（个人到系统级别）会阻止或破坏这些结果。

项目成果

How Pharmaceuticals Mask Health and Social Inequity.

• DOI: 10.1001/amajethics.2021.542
• 发表时间: 2021-07-01
• 期刊: AMA journal of ethics

Antiracist Documentation Practices - Shaping Clinical Encounters and Decision Making.

反种族主义记录实践 - 塑造临床遭遇和决策。

• DOI: 10.1056/nejmms2303340
• 发表时间: 2023
• 期刊: The New England journal of medicine
• 作者: Williams,JCorey;Andreou,Ashley;Castillo,EnricoG;Neff,Joshua;Goldenberg,Matthew;Lee,CourtneyR;Aysola,Jaya;Rohrbaugh,Robert;Isom,Jessica
• 通讯作者: Isom,Jessica