Transitioning Between Systems of Care: Missed Opportunities for Engaging Adults with Serious Mental Illness and Criminal Justice Involvement

Individuals with serious mental illness are overrepresented in the criminal justice system and face difficulties accessing mental health services both during incarceration and upon re‐entry into the community. This study examines how such individuals describe their experiences receiving care both during and after their time in custody and explores the perspectives of mental health service providers who treat this population upon re‐entry. Semi‐structured interviews were conducted with 43 individuals identified as having a history of serious mental illness and criminal justice involvement, as well as with 25 providers who have worked with this population. Clients noted the stress of transitioning to criminal justice settings, the uneven availability of services within jail and prison, and the significant challenges faced upon re‐entry. Providers reported barriers to working with this population, including minimal coordination with the criminal justice system and challenging behaviors and attitudes on the part of both clients and providers. Findings identify potential target areas for improved care coordination as well as for additional provider education regarding the unique needs of this population. Copyright © 2013 John Wiley & Sons, Ltd.     

Clients in Treatment for Alcohol Problems: Treatment Experiencesand Outcomes

This report presents an analysis of National Treatment Improvement Evaluation Study data describing the characteristics and treatment experiences of clients entering treatment for alcohol problems. Three client groups were contrasted—those entering treatment for alcohol only, for alcohol plus other drugs, or for other drugs only. Clients using alcohol only were more often white, male, and currently employed. Alcohol only clients were treated predominantly in outpatient settings. Alcohol only clients were frequently referred to treatment by the criminal justice system, and less often self-referred. In all 3 study groups, employment, general health, and mental health outcomes were improved following treatment. Illicit drug use increased marginally for the alcohol only group following treatment. No significant posttreatment reductions in reports of total abstinencefrom alcohol were found for any of the groups. Findings are discussed as they relate to research, treatment practice, and policyareas.     

Social Learning Strategies in Networked Groups

When making decisions, humans can observe many kinds of information about others' activities, but their effects on performance are not well understood. We investigated social learning strategies using a simple problem‐solving task in which participants search a complex space, and each can view and imitate others' solutions. Results showed that participants combined multiple sources of information to guide learning, including payoffs of peers' solutions, popularity of solution elements among peers, similarity of peers' solutions to their own, and relative payoffs from individual exploration. Furthermore, performance was positively associated with imitation rates at both the individual and group levels. When peers' payoffs were hidden, popularity and similarity biases reversed, participants searched more broadly and randomly, and both quality and equity of exploration suffered. We conclude that when peers' solutions can be effectively compared, imitation does not simply permit scrounging, but it can also facilitate propagation of good solutions for further cumulative exploration.     

Base property exemplification and mixed worlds: remarks on the Shafer-Landau/Mabrito exchange

In this essay I distinguish between a synchronic view of base property exemplification and a diachronic one. I argue that only a diachronic view of base property exemplification can substantiate a ban on morally mixed worlds. I then argue that one of Robert Mabrito’s recent criticisms of Russ Shafer-Landau’s moral realism fails on either a synchronic or a diachronic view.

Family Peer Advocates: A Pilot Study of the Content and Process of Service Provision

Professional family peer advocates are increasingly employed by public mental health systems to deliver family-to-family support that reduces barriers families face in accessing children’s mental health care. These services, however, are neither uniformly available nor standardized. This pilot study describes the process, content and context of family-to-family support services. Simulating a parent seeking services, a trained standardized parent participated as a client in meetings with advocates in four programs and collected data through structured observations, a structured survey, and session audiotapes. The “walk-through” process was determined to be feasible and acceptable to family peer advocates as a way of evaluating services. Four family peer advocates provided an average of 25 services during each 2-session simulation with the standardized parent, including the following: information and educational support, instruction and skills development, emotional and affirmational support, instrumental support, and advocacy. Findings also revealed variability in the range of services provided and identified challenges in aspects of service provision, such as boundaries of advocate roles, availability of confidential service environments, and addressing crises and parent concerns about child safety. This paper provides the first in-depth look at services provided by this emerging workforce.     

Women–Focused Treatment Agencies and Process Improvement: Strategies to Increase Client Engagement

Behavioral health treatment agencies often struggle to keep clients engaged in treatment. Women clients often have additional factors such as family responsibilities, financial difficulties, or abuse histories that provide extra challenges to remaining in care. As part of a national initiative, four women-focused drug treatment agencies used process improvement to address treatment engagement. Interviews and focus groups with staff assessed the nature and extent of interventions. Women-focused drug treatment agencies selected relational-based interventions to engage clients in treatment and improved four-week treatment retention from 66% to 76%. Process improvement interventions in women-focused treatment may be useful to improve engagement.