An Examination of the Psychometric Properties of the Casey Foster Applicant Inventory – Worker Version (CFAI-W)

Foster family applicants form the pool from which caregivers are selected for the day-to-day care of the many vulnerable children placed in foster care, but limited research exists concerning the reliability and validity of standardized measures for assessing the potential of foster family applicants to provide successful foster care. This dissertation examines the psychometric properties of the Casey Foster Applicant Inventory – Worker Version (CFAI-W), a paper and pencil tool designed to assess the strengths and training and service needs of family foster care applicants. Retrospective data were collected from 208 foster care workers who had at least one year of experience in licensing foster care applicants. Workers were asked to think about the best and worst foster families they had ever known and to think about these families as they knew them during the licensing process. Workers completed two copies of the CFAI-W (i.e., one for their best families and one for their worst families) and this resulted in a final sample of 712 applicants. Results indicated that CFAI-W subscales, with the exception of the Kinship Care subgroup subscale, had excellent internal consistency reliability and predicted licensure status and child placement status among foster family applicants. In conclusion, the CFAI-W is time and cost efficient, requires little training, and should be used in combination with other assessment methods to introduce standardization and accountability to the process of licensing foster family applicants

Expedited Medicaid, Mental Health Service Use, and Criminal Recidivism among Released Prisoners with Severe Mental Illness

To investigate whether Washington State’s 2006 policy of expediting Medicaid enrollment for offenders with severe mental illness released from state prisons increased Medicaid access and use of community mental health services while decreasing criminal recidivism

Enrollment and Service Use Patterns Among Persons With Severe Mental Illness Receiving Expedited Medicaid on Release From State Prisons, County Jails, and Psychiatric Hospitals

OBJECTIVE: This study examined postrelease patterns of Medicaid coverage and use of services among persons with severe mental illness who were referred for expedited Medicaid enrollment before their release from state prisons, county jails, and psychiatric hospitals in Washington State during 2006, the first year of a new policy authorizing this practice. METHODS: A retrospective cohort design was used with linked administrative data to identify persons with severe mental illness (schizophrenia, bipolar disorder, or major depression) who were referred for expedited Medicaid enrollment from state prisons (N=252), county jails (N=489), and psychiatric hospitals (N=507). For each cohort, logistic regression was used to compare those who were approved for expedited Medicaid with those who were not approved; for the 30-, 60-, and 90-day periods after release, Medicaid enrollment status and use of outpatient mental health services were also compared. RESULTS: Approval rates were higher for persons released from psychiatric hospitals (91%) and state prisons (83%) than for those released from jails (66%) (p<.001). Across settings, approval was more likely for those with a diagnosis of schizophrenia and for women (p<.001), as well as for whites and older offenders (p<.01). At the 90-day follow-up, those who were approved were more likely than those who were denied to be enrolled in Medicaid (p<.001) and to have used outpatient mental health services (p<.001). CONCLUSIONS: Expediting Medicaid benefits for persons with severe mental illness was associated with increased enrollment and outpatient mental health service use in the 90 days after release from state prisons, county jails, and psychiatric hospitals in Washington State

Probation Officers' Perceptions of Supervising Probationers with Mental Illness in Rural and Urban Settings

As part of a larger study of probation workload and workforce challenges in one southeastern state, this study reports the results from a statewide survey of probation officers’ experiences supervising probationers with mental illness. A total of 615 officers responded to closed- and open-ended questions about the challenges and barriers to supervising offenders with mental illness, and the responses of officers from rural versus urban settings were compared. Officers reported that probationers with mental illness are difficult to supervise and supervision challenges are exacerbated by a scarcity of mental health and substance abuse treatment resources, limited social support, and a lack of employment opportunities for this population of probationers. Officers report unique and similar challenges across rural and urban settings. This study contributes to our understanding of the challenges of supervising probationers with mental illness and informs practice, policy and research at the interface of the criminal justice and mental health systems

Intimate Partner Violence and Women with Severe Mental Illnesses: Needs and Challenges from the Perspectives of Behavioral Health and Domestic Violence Service Providers

Women with severe mental illnesses face high rates of violence victimization, yet little is understood about the unique needs and challenges these women present to the domestic violence and behavioral health agencies that serve them. To help address this knowledge gap, focus groups were conducted with 28 staff members from local behavioral health and domestic violence service agencies. Results from this exploratory study suggest that women with severe mental illnesses who experience intimate partner violence face additional challenges that exacerbate behavioral health and domestic violence issues and put these women at greater risk for continued victimization. DV and behavioral health agency staff experience individual-, provider-, and system-level barriers to serving this high-risk, high-need population. Recommendations and implications for domestic violence and behavioral health providers are discussed

Persons With Severe Mental Illnesses and Sex Offenses: Recidivism After Prison Release

Individuals who have committed sex offenses (ISOs) with severe mental illnesses are a complex population to serve and more research is needed to guide practice and policy, especially around community supervision, enrollment in Medicaid, housing, employment, criminal justice contacts, and reincarceration after prison reentry. To further the literature in this area, we used logistic regression to model recidivism and admissions to violator or prison facilities among 127 ISOs with severe mental illnesses and 2,935 people with severe mental illnesses who were incarcerated in prison for other crimes. Compared to prison releasees with severe mental illnesses who committed crimes other than sex offenses, prison releasees with severe mental illnesses who committed sex offenses were admitted to violator facilities at higher rates, when controlling for substance use, Medicaid enrollment, homelessness, and unemployment. Implications for practice, policy and research are discussed

Tiny Homes Are Huge for People Living With Serious Mental Illness

Purpose: A formative evaluation examined the acceptability and feasibility of tiny homes for people living with serious mental illness (SMI). Methods: The evaluation included four focus groups with people with SMI and service providers ( n = 28) and eight overnight stays with people with SMI. Results: The analysis identified six recommendations for tailoring the design of the tiny homes and the community where the homes will be located to meet the needs of people living with SMI. The recommendations for the design of the tiny homes included maximize natural light and outdoor spaces, design flexible living spaces, and ensure accessibility. The recommendations for the design of the surrounding community included ensure privacy, build a community, and maximize residents’ connectivity. Conclusions: This research serves as a starting point for interventions that aim to develop housing that is both affordable and tailored to the needs of people with SMI

Using the Consolidated Framework for Implementation Research to examine implementation determinants of specialty mental health probation

Background Specialty mental health probation (SMHP) is designed to improve outcomes for the large number of people with serious mental illnesses who are on probation and/or parole. The evidence for specialty mental health probation is promising; however, little is known about the implementation challenges and facilitators associated with SMHP. To address this gap, we used the consolidated framework for implementation research (CFIR) to analyze 26 interviews with stakeholders representing multiple agencies involved in the implementation of SMHP. Results Results indicate a number of challenges and facilitators related to the inner setting, outer setting, implementation process, and characteristics of individuals. Conclusions Findings suggest that complex and cross-sectoral interventions are context-dependent and introduce a number of challenges and facilitators related to multiple CFIR domains. Consequently, agency administrators implementing these types of interventions should consider small pilot studies and develop implementation strategies tailored to the local implementation context

Using statewide administrative data and brief mental health screening to estimate the prevalence of mental illness among probationers

There is little published information about the measures that probation agencies in the United States use to identify individuals with mental illnesses who are under community supervision. This study used statewide administrative data to estimate and compare the prevalence of mental illnesses among probationers using officer report and offender self-report data. Prevalence estimates of mental illnesses ranged from 15 percent to 19 percent, which is consistent with prior studies that used formal diagnostic assessments. In the absence of costly and time-consuming diagnostic assessments, probation agency-developed mental health scales can aid in identifying those who might be in need of additional mental health assessment

Segmented Versus Traditional Crisis Intervention Team Training

There are more than 2,500 Crisis Intervention Teams (CIT) in operation across the country. Results of research on the effectiveness and impact of CIT are mixed. One aspect of CIT training that has yet to be examined is the expert-derived suggestion that 40 consecutive hours of training is an essential element of CIT for law enforcement officers. That is, CIT training is delivered in one 40-hour week, but it is unclear whether the training could be delivered in segments and still achieve its desired outcomes. Segmented training could make CIT more accessible to smaller, particularly rural, law enforcement agencies. Can segmented CIT achieve outcomes similar to those of traditional CIT training? We compared the knowledge and attitudes of 47 police officers who received traditional CIT training and 32 officers who received segmented CIT training. Our findings suggest that segmented CIT training and traditional CIT training produce comparable results regarding officers' knowledge of mental illness and attitudes toward persons with mental illness, providing preliminary support for this adaptation to the delivery of CIT training