What works, for whom? Applying novel precision medicine methods to people with mental illness in the justice system.

项目总结/摘要 严重精神疾病（SMI）患者在美国刑事司法系统中的比例过高。在 努力减少这一弱势群体中的累犯， 近年来研究了对所有人的干预措施。这些干预措施包括针对SMI症状的干预措施 (such作为强制性精神病服务）和其他针对犯罪风险因素（如认知 行为疗法）。然而，涉及司法的SMI患者的特征、需求和 风险因素;没有“一刀切”的预防累犯的解决办法。减少不利的犯罪结果 需要认识到它的异质性。因此，本建议的总体目标是 使用最先进的技术，了解哪些干预措施最适合哪些司法介入的SMI患者 从因果推理、统计理论和机器学习中得出的精准医学方法。这是一个步骤 为了实现长期目标，确定最佳方法，以减少犯罪行为，在这一人口的匹配 向需要并从中受益的人提供干预措施。在一个专注而有才华的导师团队的支持下， 这笔赠款的培训部分将填补实现这一目标的关键空白：1）主题培训和实地 刑事司法系统中SMI的经验，2）开发新的技术方法， 3）将技术发现转化为实践和政策的高影响力建议的技能，以及 4)专业技能发展。这一丰富的培训将为完成以下任务奠定基础 研究旨在实现该提案的广泛目标：1）了解导致这一问题的不同途径 有重新犯罪风险的人口，2）确定针对受益者的干预措施的具体规则 从他们的基础上的个人特点，和3）评估是否和如何识别的规则匹配 干预措施在美国各地推广。这项研究将利用随机对照试验数据，联邦数据 来自美国法院行政办公室的数据和来自北卡罗来纳州公共部门的州数据 安全，以实现这些目标。重要的是，这项资助的研究将导致新的统计精度 将规则传输到不同于学习规则的环境的医学方法。的目的 该补助金与NIMH的战略目标非常一致，即努力在患有糖尿病的人群中进行预防和治疗。 SMI，包括但不限于以下目标：a）推进使干预措施与个人相匹配的方法 （特别是边缘化和得不到充分服务的社区）和B）扩大战略 最大限度地发挥公共卫生影响。通过了解谁从哪些干预措施中受益， 最新进展的精确医学方法，这项工作有可能帮助停止所谓的“旋转 “监狱大门”为涉及正义的人与SMI。此外，这项研究将推进数据支持的工具包， 精准医疗战略，最有效地提高公共卫生和安全。

PROJECT SUMMARY/ABSTRACT People with serious mental illness (SMI) are substantially overrepresented in the US criminal justice system. In an effort to reduce recidivism among this vulnerable population, average effects of administering single interventions to all have been studied in recent years. These interventions include ones that target SMI symptoms (such as mandated psychiatric services) and others that target criminogenic risk factors (such as cognitive behavioral therapy). However, justice-involved people with SMI are diverse in their characteristics, needs, and risk factors; there is no “one-size-fits-all” solution to prevent recidivism. Decreasing adverse criminal outcomes for this population requires recognizing its heterogeneity. Therefore, the broad objective of this proposal is to understand which interventions work best for which justice-involved people with SMI using state-of-the-art precision medicine methods drawn from causal inference, statistical theory, and machine learning. This is a step toward the long-term goal of identifying optimal ways to reduce criminal behavior in this population by matching interventions to those who need and benefit from them. Supported by a dedicated and talented mentorship team, the training portion of this grant will fill gaps key to achieving this goal: 1) subject-matter training and field experience on SMI in the criminal justice system, 2) development of novel technical methods in precision medicine, 3) skills in translating technical findings to high-impact recommendations for practice and policy, and 4) professional skills development. This rich training will provide a foundation for accomplishing the following research aims to reach the proposal's broad objective: 1) understand the differential pathways that situate this population at risk for re-offending, 2) identify tailored rules for administering interventions to those who benefit from them based on individual characteristics, and 3) assess whether and how the identified rules for matching interventions generalize across the US. This research will leverage randomized controlled trial data, federal data from the Administrative Office of the US Courts, and state data from the North Carolina Department of Public Safety to achieve these aims. Importantly, research from this grant will result in novel statistical precision medicine methods for transporting rules to settings different than those on which they are learned. The aims of this grant are well-aligned with NIMH's strategic goal of striving for prevention and treatments among people with SMI, including, but not limited to, the objectives of: a) advancing methods to match interventions to individuals and populations (especially marginalized and underserved communities) and b) strategies for scaling up interventions for the greatest public health impact. By learning who benefits from which interventions using the latest advances in precision medicine methods, this work has the potential to help stop the so-called “revolving prison door” for justice-involved people with SMI. Further, this research will advance the toolkit for data-supported precision medicine strategies that most efficiently and effectively increase public health and safety.