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.

项目总结/摘要 这份职业发展提案将支持恩里科·卡斯蒂略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， 在进行混合方法研究方面的专门知识，以提高公共系统消除 健康和社会不平等的经验与SMI的个人。患有SMI的人会经历严重的 在无家可归者和教养设施中， 与SMI严重过度代表。这些全国性的挑战反映在洛杉矶县， 拥有美国最大的无庇护的SMI患者群体。洛杉矶县监狱是最大的 世界上最好的设施，用于限制患有SMI的人。面对稀缺的公共精神卫生资源 以及精神病患者在监狱中的集中，一些人认为监狱可能起到重要的作用， 公共卫生功能和积极的心理健康影响与SMI的个人。这引起了重要的 科学问题。卡斯蒂略博士计划将他的研究重点放在了解未得到满足的健康和社会 通过研究监禁对随后的健康和社交的影响，满足重度精神分裂症患者的需求 从监狱到无家可归的管道。卡斯蒂略博士的建议集中在指导职业生涯 发展和研究活动，将发展技能，以实现这些职业目标：1）定量 分析相关的行政数据，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）刑事司法系统和涉及司法的弱势群体， （4）传播卫生服务研究成果，并将其转化为政策和实践。鉴于 在监狱释放后研究个人的挑战，相对较少了解确切的关系 监禁和随后的无家可归之间的关系及其对医疗保健和社会的下游影响 重度精神障碍患者的生活轨迹此外，护理系统分散，数据基础设施孤立 研究、护理协调、资源分配和公共卫生规划的障碍。解决这些 卡斯蒂略博士的研究项目将1）使用现有的八个公共链接的行政数据库。 洛杉矶县的服务机构，以了解监狱是否会破坏心理健康和社会 服务使用和住房稳定的人与SMI; 2）进行档案研究和直接人种学 在洛杉矶县监狱的观察，以阐明监狱的经验和服务，并确定 监禁后轨迹的基本机制;以及3）准备R 01卫生服务研究补助金 （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R 01将采用相同的混合方法来调查机构的完整电路， 累犯（重新监禁、住院、无家可归），以确定公共服务使用轨迹， 程序和其他可变因素（个人到系统层面），防止或破坏这些结果。

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