Factors Associated with Drug Treatment Entry Patterns Among Hispanic Women Injection Drug Users Seeking Treatment

SUMMARY

This paper examines patterns of drug treatment entry and factors that are associated with these patterns among 1,849 Hispanic women injection drug users (IDUs). The data analyzed originates from a statewide drug-treatment database covering seven years, 1996–2002. Through the use of logistic regression analyses, the study identified significant differences in predisposing, need and enabling factors in the use of detoxification only, residential treatment, or methadone maintenance. Compared to other Hispanics, Puerto Rican women were 40 percent less likely to use only detoxification services and one and a half times more likely to use methadone maintenance. Having health insurance was an especially important factor associated with methadone treatment utilization. Two of the most important factors associated with residential treatment use were history of mental health services utilization and involvement with the criminal justice system. This article discusses specific social work practice implications including the need for social work practitioners to promote services such as residential treatment, to be trained in treatment of co-occurring mental health disorders, especially among women in residential treatment, and the need to establish close linkages with the mental health and criminal justice systems.     

Estimating the cost impact of three dual diagnosis treatment programs

Specialized intervention programs for people with concurrent severe mental illness and substance abuse reduce the total costs of care. Compared to baseline, cost savings of over 40% were achieved by 18 months, primarily due to significant reductions in the use of acute and subacute mental health services and despite an increase in outpatient mental health services. There also was an observable impact on cost reductions in medical and criminal justice services without an increase in family costs over the same time period.     

The impact on taxpayer costs of a jail diversion program for people with serious mental illness

Mental illness is prevalent among those incarcerated. Jail diversion is one means by which people with mental illness are treated in the community – often with some criminal justice system oversight – instead of being incarcerated. Jail diversion may lead to immediate reductions in taxpayer costs because the person is no longer significantly engaged with the criminal justice system. It may also lead to longer term reductions in costs because effective treatment may ameliorate symptoms, reduce the number of future offenses, and thus subsequent arrests and incarceration. This study estimates the impact on taxpayer costs of a model jail diversion program for people with serious mental illness. Administrative data on criminal justice and treatment events were combined with primary and secondary data on the costs of each event. Propensity score methods and a quasi-experimental design were used to compare treatment and criminal justice costs for a group of people who were diverted to a group of people who were not diverted. Diversion was associated with approximately $2800 lower taxpayer costs per person 2 years after the point of diversion (p < .05). Reductions in criminal justice costs drove this result. Jail diversion for people with mental illness may thus be justified fiscally.     

Forensic nurses' views regarding medications for inmates

1. High arrest rates among people with mental illnesses may suggest that the illness is a factor in their arrests. 2. The increased number of individuals with severe and persistent mental illnesses in the criminal justice system reflects deficient community-based mental health services. 3. Jails and prisons act as revolving-door treatment facilities and are a poor substitute for proper community-based mental health care. 4. Mandatory discharge medication and follow-up treatment for ex-inmates with mental illnesses may lower the rate of recidivism.     

A 10 year follow-up study of young people reported missing to the police for the first time in 2005

Young people who go missing face significant risks and vulnerabilities, yet there has been limited research looking their longer-term criminal justice-related outcomes. The aim of this study was to explore the criminal justice and mental health-related trajectories of a random sample of 215 young people reported missing for the first time in 2005, followed up for a decade. Two thirds (64.7%) of the sample had accumulated an offence history and 68.4% a victimisation history. More than a third were reported missing multiple times; these youth were characteristically different to single episode missing persons with respect to police contacts and mental health-related vulnerability. Results highlight a significant level of mental health concern among a population that police are not adequately equipped to respond to. Further research is needed to better understand motivations for going missing and the extent of risks and vulnerabilities they face while missing and upon return.     

Victim service and justice system representative responses about partner stalking: what do professionals recommend?

Research suggests that partner stalking is associated with reassault and lethality as well as increased psychological distress for victims. However, there is a significant gap in information about stalking interventions and the responses of health, mental health, law enforcement, social services, and criminal justice professionals to women experiencing partner stalking. The purpose of this study is to examine the ideas about appropriate and effective responses to stalking victims from professionals in victim services and the justice system. The study also examined differences among rural and urban representatives because prior studies have shown significant differences between rural and urban areas on experiences and responses to partner violence. A total of 152 key informants (38 urban and 114 rural) were interviewed. Study results suggest a need for more training for victim services and justice system professionals on stalking and service needs of women who experience stalking in the context of partner violence.     

Data-Mining Client Concerns in Adolescent Mental Health Services

Summary

Via a practice-based research collaboration, clinicians, supervisors, and managers in an urban adolescent mental health program studied previously collected intake information concerning adolescent risk exposures, behaviors, worries, and self-assessed coping. In addition, desire to talk with a mental health counselor about specific risks and worries was systematically analyzed with the aim of generating practice insights into the clinical challenge of engaging urban adolescents in mental health services. Though provided with research consultation, practitioners were full participants in all aspects of the researchprocess. This organizational development process placed strains on the participants and organization, but many benefits were derived from it. One significant benefit was that mining the expressed concerns of clients gave participants a powerful vehicle for reshaping services. The organization came to see its clients as more than mere service recipients, resulting in a recommitment to Youth Development principles and a renewed effort to increase direct client participation in organizational life.     

Mental Illness and the Criminal Justice System

This is the second essay in a two‐part series exploring the relationships between mental illness, criminal behavior, and the criminal justice system. The number of mentally ill persons in prisons and jails has increased substantially over the last several decades, and there are currently more people with mental illness behind bars than there are in mental hospitals. In this essay, we place these trends within a broader historical context of the social control of mental illness in the United States. We identify how and why mentally ill persons have come to be overrepresented in the criminal justice system and highlight the unique challenges this population poses for police, courts, and correctional facilities. Finally, we review several recent innovations in policy and practice that may help alleviate that burden of criminal justice involvement on mentally ill offenders, as well as the burden of mentally ill offenders on the criminal justice system.     

Collaborating for consensus: Considerations for convening Coalition stakeholders to promote a gender-based approach to addressing the health needs of sex workers

Women involved in sex work experience myriad challenges, such as poverty, illiteracy, low social status and gender inequity, as they struggle to access healthcare. These challenges place them at high risk for poor health outcomes. The purpose of this article is to describe the formation of a strong cross-system Coalition representing both the criminal justice and healthcare systems to address the health needs of sex workers in Delaware. The Delaware Coalition for Health and Justice implemented a Coalition-building strategy to design interventions and streamline systems to promote health and reduce criminal justice contact for sex workers. The sequential intercept model was utilized to organize Coalition membership and build consensus among varied stakeholders. The model assisted the Coalition in understanding differing primary objectives for key system programs, recognizing the limitations and barriers of each stakeholder group, sharing findings and discovering opportunities for partnership, and engaging stakeholders in designing and providing a comprehensive “systems” approach. This work suggests that aligning the criminal justice, healthcare, and community social services in a systemic process to build consensus can result in the implementation of effective systems change initiatives that address gender disparities and promote the health of justice-involved women.     

Predicting program success for adult offenders with serious mental illness in a court ordered diversion program

ABSTRACT

Individuals with mental illnesses are disproportionately involved with the criminal justice system and are now being diverted from jails to community-based supervision. This study examines secondary data from a state hospital, mental health diversion program. Logistic regression was used to examine risk factors that best predicted successful program completion. Results indicate that non-whites are more likely to complete. Participants in supervised housing, ever been re-hospitalized, diagnosed with a depressive or psychotic disorder or who had their probation revoked were less likely to complete. Findings indicate practitioners should provide a holistic and individually oriented treatment approach for success.     

Lesbian,Gay, Bisexual,and Queer People's Perceptions of the Criminal Justice System: Implications for Social Services

Previous literature has found historically marginalized groups report more negative perceptions of the criminal justice system and lower levels of procedural justice, which then influences their mental health and their willingness to report crimes. While previous research on procedural justice has focused mostly on racial and ethnic minority groups, it is hypothesized that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals would also report negative experiences of the criminal justice system. The current study utilized focus groups with 16 participants who identified as lesbian, gay, bisexual, and queer (LGBQ), with ages ranging from 26 to 35 years (M = 30.5 years, SD = 3.5). Participants were asked open-ended questions about how they felt about various aspects of the criminal justice system (e.g., police officers, courts, legal processes, etc.). Through the consensual qualitative research (CQR) process, researchers identified five domains that influenced participants’ experiences of the criminal justice system: (a) gender presentation, (b) influences of intersectional identities, (c) systemic and political issues, (d) experiences of discrimination, and (e) help-seeking behaviors and the criminal justice system. Implications for social services are discussed.     

A qualitative investigation into military veterans’ experiences in a problem-solving court: Factors that impact graduation rates

Veterans treatment courts (VTCs) are designed to offer a rehabilitative approach to criminal justice, focusing on treatment for mental health and substance use disorders. This qualitative study develops an in-depth understanding of a Midwestern VTC by asking participants (n = 15) their views on the most helpful aspects of the program and how the program could be more helpful. Three themes emerged from the data. 1) Military veterans felt that they were treated in a compassionate and caring manner, while also being held accountable for their behaviors. 2) Military veterans felt that they were not labeled by their mental health diagnoses, but that their identities as people and military veterans were more fully recognized. 3) Military veterans were dissatisfied with some of the services they received from the local VA. These findings are discussed in the context of problem-solving courts and military veterans’ experiences of services.     

Problem‐Solving Courts: Theory and Practice

Problem‐solving courts (PSCs) are a popular and fast‐growing alternative to the usual way of handling criminal cases. In place of the adversarial process, they provide court‐supervised treatment to certain groups of offenders by addressing the underlying causes of criminal behavior. They take on a variety of forms including drug courts, mental health courts, domestic violence courts, veterans’ courts, and homeless courts. PSCs, as relatively new innovations in the criminal justice system, are still evolving in scope and in practice. This article then attempts to synthesize what we know about these specialty dockets. To do so, this article (1) explores the origins and developments of PSCs as well as highlights their defining characteristics; (2) examines the theoretical approaches and empirical findings of contemporary research on problem‐solving courts; (3) critically discusses whether this new approach to old problems compromises core judicial principles; and (4) suggests directions for further research to better understand the cautionary promise of problem‐solving justice.     

Peer contagion among youth in Medicaid-funded residential mental health treatment programs

This paper examined juvenile justice encounters among youth with mental health needs who received care in residential treatment settings. The focus is on peer effects, and whether delinquent peers negatively affected youth. Matched data from Florida Medicaid and Juvenile Justice were used to examine the association between peer delinquency in a residential treatment setting and juvenile justice encounters during and after the treatment episode. Fifteen percent of youth had justice encounters during residential out-of-home treatment, while the rate was lower in the six months after (23.0%) treatment than the six months before (33%). Support for peer contagion was found as youth treated in Medicaid-funded residential mental health treatment programs were more likely to have JJ encounters when the other youth in the facility had histories of delinquency.     

Youthful Offending and Delinquency: The Comorbid Impact of Maltreatment,Mental Health Problems,and Learning Disabilities

A majority of adolescents formally involved in juvenile court have at least one, if not more than one, significant emotional or learning impairment, or maltreatment experience. This is particularly true in juvenile detention and incarceration facility populations. While this problem is increasingly recognized within the juvenile justice system and social work profession, often the impact and correlation to delinquency of these child and youth difficulties is underestimated. This paper reviews the links from mental health disorders, learning (and academic-related) disabilities, and maltreatment victimizations to delinquent and serious youthful offending behaviors, and provides successful collaboration outcome examples to address this problem. The most difficult challenge to juvenile courts and youth-caring systems is working with adolescents and families with comorbid difficulties, for this group is most at risk for incarceration and involvement with the adult criminal justice system.     

Mental health professionals in children's advocacy centers: is there role conflict?

Two recent chapters in professional books have criticized children's advocacy centers for creating role conflict for mental health professionals because of their work with criminal justice and child protection professionals in children's advocacy centers as part of a coordinated response to child abuse. This article argues that these critiques misunderstand children's advocacy center practice and overestimate the risk of role conflict. Children's advocacy center standards set a boundary between forensic interviewing and therapy, which in most children's advocacy centers are done by separate professionals and never by the same professional for a given child. Many mental health professionals serve children's advocacy centers as consultants with no treatment role. Children's advocacy center therapists are rarely involved in investigation, and their participation in multidisciplinary teams focuses on children's interests and well-being.     

Drug Courts and the Logic of Coerced Treatment1

This article examines the social and historical significance of coerced drug treatment within the criminal justice system. Drug courts, the most prominent example of this approach, serve as a case study to explore how seemingly contradictory perspectives on substance use—therapeutic and punitive—are merged to justify increased criminal justice oversight of defendants in the name of facilitating recovery. Drawing on an analysis of drug court organizational documents and interviews with key advocates, this article (1) examines the punitive, therapeutic, and medical knowledge drug court advocates draw on and construct to justify an increased role for the courts in solving the problem of addiction, and (2) links these theories historically to broader discussions about the causes of crime and the courts’ role in solving social problems. Overall, this article considers how scientific theories are fused with moral considerations in the name of an “enlightened” criminal justice approach to complex social problems.     

Rural and urban women's perceptions of barriers to health, mental health, and criminal justice services: implications for victim services

The purpose of this study was to examine rural and urban women's perceptions of barriers to health and mental health services as well as barriers to criminal justice system services. Eight focus groups were conducted, two in a selected urban county (n = 30 women) and two in each of three selected rural counties (n = 98 women). Results were classified into a barrier framework developed in the health service utilization literature which suggests there are four main dimensions of barriers: affordability, availability, accessibility, and acceptability. Results indicate that: (1) women face many barriers to service use including affordability, availability, accessibility, and acceptability barriers; (2) it takes an inordinate level of effort to obtain all kinds of services; however, women with victimization histories may face additional barriers over and above women without victimization histories; (3) barriers to health and mental health service utilization overlap with barriers to utilizing the criminal justice system; and (4) there are many similarities in barriers to service use among rural and urban women; however, there are some important differences suggesting barriers are contextual. Future research is needed to further clarify barriers to service use for women with victimization histories in general, and specifically for rural and urban women. In addition, future research is needed to better understand how women cope with victimization in the context of the specific barriers they face in their communities.     

The impact of partner stalking on mental health and protective order outcomes over time

The goals of this article are to examine stalking victimization over time among a large sample (n = 662) of women who received a protective order against a violent partner and to examine the impact of stalking on mental health and protective order outcomes. Findings suggest that stalking is a significant risk factor for other forms of partner violence (e.g., psychological, physical, and sexual violence) and that the experience of being stalked by a violent partner contributes uniquely to women's perceptions of psychological distress, personal safety, and perceptions of protective order effectiveness. Both the criminal justice system and victim service representatives need to be vigilant in educating women about the increased risk of stalking to their safety and mental health. Further, study findings suggest that stalking must be addressed to prevent future physical and psychological harm in partner violence cases.     

Crossover Children: Examining Initial Criminal Justice System Contact Among Child Protection-Involved Youth

ABSTRACT

Child protection-involved youth face increased risk of criminal justice system contact. Such “crossover children” experience earlier police involvement and more serious criminal justice sanctions, yet little is known about their early offending. Using a cross-sectional sample of 300 crossover children before three Victorian Children's Courts in 2016–17, this mixed-methods study examines the nature and context of children's initial police charges. Findings indicate that crossover children are initially charged with disproportionately violent offending, and often incur first police charges around the time of initial care placement. For many, initial criminal justice contact occurred in the context of conflict with caregivers, ongoing maltreatment, and household adversity, or emotional and behavioural regulation challenges. Efforts towards preventing offending for child-protection-involved youth should focus on preventing childhood maltreatment, alongside targeting parent–child relationship challenges, and strengthening community and care system responses that address the impacts of complex trauma, mental health problems, and neurodisability.

IMPLICATIONS

• Compared to all sentenced children, those from statutory child protection backgrounds are charged with more serious offending at their first criminal court adjudication.

• Among “crossover children”, earlier police charges were seen for Indigenous children, those experiencing greater cumulative maltreatment, and children with emotional or behavioural challenges related to trauma, mental health, and neurodisability.

• Crossover children are most often first charged by police in the year before, and after, their first out-of-home care placement.