Policy and interventions for adults with SMI and criminal justice involvement

艾利森·罗伯逊博士成为一名独立的调查员，进行以证据为基础的政策和实施研究，以改善严重精神疾病（SMI）和经常共同发生的物质使用障碍（COD）参与刑事司法（CJ）系统的人的治疗和减少累犯。患有SMI的人，尤其是那些患有COD的人，在美国CJ系统中的比例过高。在过去的20年里，已经制定了许多政策和计划干预措施，将SMI患者从CJ系统转移到以社区为基础的精神健康和药物滥用治疗中，所有这些都希望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;药物滥用是累犯的主要预测因素。此外，很少有人注意到在广泛采用和实施针对这一人群的循证干预措施方面存在的政策和业务层面的挑战。Robertson博士的目标是将她未来的研究重点放在为SMI和CJ参与者确定有效的治疗方法上，并改善基于证据的政策和实践的采用和实施，以改善健康结果并减少累犯。为此，她在这个职业发展奖中提出了一套指导性的培训和研究活动，以发展新的技能来实现她的职业目标。罗伯逊博士将在以下方面发展更多的专业知识：（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，密切关注围绕循证实践实施的问题;以及（2）实施科学和研究，包括利益相关者调查方法的新培训，进行关键信息提供者访谈的一些定性研究培训，和多层次建模，用于测试环境内和环境间的干预效果。她将指导培训与一套研究项目配对，研究使用循证药物滥用药物与心理社会治疗配对-也称为药物辅助治疗（MAT）-用于治疗司法参与者中同时发生的药物滥用SMI。很少有人知道使用MAT的COD和司法参与的人，但MAT的证据基础是强大的，前景是巨大的，更广泛地使用这些治疗方案，以减少药物滥用，随后的刑事犯罪，并促进SMI恢复。在她的研究项目中，Robertson博士将（1）使用2002-2009年期间康涅狄格州COD和CJ参与的成年人的现有合并管理数据，以估计MAT与SMI治疗结合使用的有效性和渗透率（相对于单独的SMI治疗）;（2）对相关利益相关者进行两个州的调查，并对关键知情人进行访谈，以评估临床系统，和政策考虑，以更广泛地采用和实施MAT用于涉及COD的成年人;以及（3）准备R34实施试点研究，以改善MAT在这一人群中的使用。R34开发活动将包括确定适当的实施理论进行测试;设计MAT实施的实验干预措施;以及早期起草MAT实施干预措施手册。本文提出的培训和研究将在授予期间为NIMH R34应用奠定基础，该应用本身将在随后的多地点实施MAT试验之前为参与CJ系统的COD患者进行试验。

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.