Policy and interventions for adults with SMI and criminal justice involvement

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.