RTI Helps Integrate HIV Testing, Treatment Into Jail Diversion Programs
If you examine the criminal justice population -- arrestees, jail and prison inmates, parolees -- you will find that people suffering from both mental illness and substance abuse (known as co-occurring disorders) are disproportionately represented. In fact, this population is twice as likely to have a serious mental illness than people in society at large, and at least three-quarters of mentally ill offenders are believed to have co-occurring drug or alcohol problems.
Once in the justice system, mentally ill offenders tend to cycle in and out of jail, amassing a history of both misdemeanor and felony convictions. In fact, almost half are back in jail within one year.
The presence of mental illness and substance abuse in the system increases the burden on jail mental health services and presents a number of challenges for police, courts, prison staff, and other criminal justice personnel.
To address this problem, a number of jurisdictions have developed what are known as diversion programs to move those with co-occurring disorders out of the criminal justice system and into quality mental health and substance abuse programs. Ideally, these programs help to get these offenders out of the revolving door of incarceration. Diversion programs may involve training police to identify and divert offenders prior to arrest, or arrestees may be diverted by the court or jail systems after being booked (known as post-booking diversion) but prior to sentencing.
Today, recognizing that people with serious mental illnesses and substance abusers have an elevated risk for HIV infection, these programs are being expanded to include HIV prevention and intervention. According to Dr. Nahama Broner, a senior research psychologist at RTI, "When you combine all these risk factors, you have a much greater risk for and a higher rate of HIV infection and AIDS."
Evaluating Brooklyn’s Jail Diversion and HIV Intervention Program
Dr. Broner and RTI have recently undertaken the first comprehensive evaluation of a jail diversion program that integrates HIV prevention and intervention with mental health and substance abuse treatment. RTI will document the Brooklyn, N.Y., program and its effects on participants by analyzing data collected from self-report questionnaires and focus groups, as well as program data.
"We’ll be looking at how the program impacts both the client and the system -- for example, how well does the program increase a client’s knowledge of HIV, affect risk behaviors, and decrease transmission, as well as how well integrated are the services, and what types of collaborations have been developed to meet the needs of the population," said Dr. Broner.
The project is funded by the Education and Assistance Corporation's Treatment Alternatives to Street Crimes (EAC-TASC) program and the Substance Abuse and Mental Health Services Administration (SAMHSA), through its Center for Substance Abuse Treatment.
Designing an HIV Intervention Program for the Bronx Mental Health Court
In a parallel effort also under Dr. Broner’s direction and funded by EAC-TASC and SAMSHA’s Center for Substance Abuse Prevention, RTI is helping develop a strategic plan for integrating HIV and substance abuse prevention into a mental health court in the Bronx. A relatively new phenomenon, mental health courts are adult criminal courts with a separate docket and resources dedicated to persons with mental illnesses. These courts divert criminal defendants into treatment programs, monitor their treatment, and can impose criminal sanctions for failure to comply.
"The overall purpose of this project," said Dr. Broner, "is to integrate and adapt evidence-based practices for integrated HIV and substance abuse prevention strategies for the seriously mentally ill. We want to both develop a new model of services for this population and extend the help the mental health court is able to provide to those who are at risk for HIV or who are HIV positive and at risk for continued transmission."
As part of Phase I of this project, RTI brought together a panel of diverse stakeholders (e.g., consumers, family members, policy makers, criminal justice representatives and health, mental health and substance abuse providers), coordinated local and national expert presentations, oversaw the development of a strategic plan, and determined whether planning goals have been met.
Under Phase II of the project, recently awarded to RTI by EAC-TASC and SAMHSA, RTI will evaluate the implementation of prevention strategies for offenders who come through the Bronx Mental Health Court with co-occurring disorders and who are HIV positive or at risk for HIV infection. The evaluation will include a study of the panel’s continued work, the program’s implementation of the agreed-upon model, and the effect of these integrated strategies on substance abuse, mental health, and health outcomes for participants.
Building on Groundbreaking Research
RTI was the coordinating center for the first multisite study of diversion for people with serious mental illness and co-occurring substance use in the U.S. funded by SAMHSA's Center for Mental Health Services and Center for Substance Abuse Treatment. RTI prepared and disseminated study findings in a series of articles. The study’s baseline results, led by Pamela Lattimore, were published in the Journal of Contemporary Criminal Justice, and final results (see abstract), led by Broner, appeared in Behavioral Sciences and the Law. A third article, led by Alexander Cowell and also published in the Journal of Contemporary Criminal Justice, documents the first cost analysis of diversion programs.
RTI International has been conducting research on crime and justice issues since the 1970s. We bring together experts in criminology, economics, law, psychology, public health, sociology, and many other fields to help inform public policy and practice. RTI also has decades of experience helping plan, manage, and evaluate HIV intervention and prevention programs, both in the U.S. and abroad. Additional information about RTI’s research in crime and justice policy and highlights of our recent work related to HIV/AIDS is available at our web site.
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