Forging New Paths: Building Interventions to Treat Criminogenic Needs in Community Based Mental Health Settings

摘要 传统的精神卫生服务未能显著减少不成比例的参与， 刑事司法系统中的严重精神疾病患者突出了一个基本但被忽视的事实： 精神疾病不是刑事司法介入的主要驱动因素。研究一直表明， 患有精神疾病的人面临同样的司法参与风险因素（即，“致犯罪”风险因素）， 那些没有精神疾病的人。研究还发现，司法参与的人与SMI有高水平的 这些风险因素介导了他们再次犯罪的风险。然而，大多数干预措施 对于涉及正义的SMI患者，不将致犯罪风险因素作为治疗目标。这一差距 研究和服务提供之间的差距代表了未开发的潜力，以减少司法参与率 在重度精神障碍患者中，通过扩大他们的连续服务，包括直接针对 犯罪风险因素。我们最近的NIMH资助的随机对照试验（1 R34 MH 111855 -01; PI：Wilson） 表明，当适应用于与SMI的人，犯罪发生为重点的干预措施， 成功地将与犯罪风险因素相关的关键治疗目标和结果纳入 囚犯与SMI鉴于高达50%的重度精神分裂症患者在社区接受治疗， 精神卫生系统有一些刑事司法系统的参与，发展犯罪发生为重点， 在社区精神卫生环境中提供的干预措施有很大的潜力，以优化其潜力 影响，无论是在可以受益的SMI患者人数方面，还是在潜在的减少方面， 未来的刑事司法。这项R34提案汇集了一个国家认可的专家团队， 采用以部署为中心的方法，开发和初步测试一种新的、可扩展的， 制定了可持续的基于群体的、以犯罪发生为重点的认知行为治疗干预 特别是在社区精神健康环境中的SMI患者中使用。这项拟议的研究 包括三个目标。第一个目标是采用以用户为中心的设计方法， 发展新的干预措施。第二个目标是进行一项小型的随机对照试验， 测试新干预措施的初步效果。这项试点试验将采用一种实验性的 治疗方法，以检查新的干预措施如何与预期的治疗靶点结合， 结果。第三个目标是与主要利益攸关方一起使用定性研究方法， 最大化和加快新干预措施的可扩展性和可持续性的战略， 以社区为基础的心理健康机构。

ABSTRACT The failure of traditional mental health services to significantly reduce the disproportionate involvement of people with serious mental illnesses (SMI) in the criminal justice system highlights a basic but overlooked fact: mental illness is not a primary driver of criminal justice involvement. Research has consistently shown that people with mental illness face the same risk factors for justice involvement (i.e., “criminogenic” risk factors) as those without mental illnesses. Research has also found that justice-involved people with SMI have high levels of criminogenic risk factors and that these risk factors mediate their risk of recidivism. Yet, most interventions for justice-involved people with SMI do not target criminogenic risk factors as a goal of treatment. This gap between research and service provision represents untapped potential to reduce rates of justice involvement among people with SMI, by expanding their continuum of services to include interventions that directly target criminogenic risk factors. Our recent NIMH-funded randomized controlled trial (1R34MH111855-01; PI: Wilson) demonstrated that when adapted for use with people with SMI, criminogenic-focused interventions can successfully engage key treatment targets and outcomes associated with criminogenic risk factors among prisoners with SMI. Given that up to 50% of people with SMI receiving treatment in the community-based mental health system have had some criminal justice system involvement, developing criminogenic-focused interventions for delivery in community mental health settings has great potential to optimize their potential impact, both in terms of the numbers of people with SMI who can benefit and in terms of potential reductions in future criminal justice involvement. This R34 proposal brings together a team of nationally recognized experts to engage a deployment-focused approach to the development and preliminary testing of a new, scalable, and sustainable group-based, criminogenic-focused cognitive-behavioral therapy intervention developed specifically for use among people with SMI in community-based mental health settings. This proposed study includes three aims. The first aim will engage user-centered design methodologies to optimize the development of the new intervention. The second aim will conduct a small pilot randomized controlled trial to test the preliminary effectiveness of the new intervention. This pilot trial will engage an experimental therapeutics approach to examine how the new intervention engages the intended treatment targets and outcomes. The third aim will use qualitative research methods with key stakeholders to identify implementation strategies that both maximize and expediate the scalability and sustainability of the new intervention in community based mental health settings.