Biomedical subjects

Henry J Steadman

Publications and source records attributed to Henry J Steadman.

15 recordsLinked to original sources

PubMed2006

The classification of violence risk.

The Classification of Violence Risk (COVR) is an interactive software program designed to estimate the risk that a person hospitalized for mental disorder will be violent to others. The software leads the evaluator through a chart review and a brief interview with the patient. At the end of this interview, the software generates a report that contains a statistically valid estimate of the patient's violence risk-ranging from a 1% to a 76% likelihood of violence-including the confidence interval for that estimate, and a list of the risk factors that the program took into account to produce the estimate. In this article, the development of the COVR software is described and several issues that arise in its administration are discussed.

Antisocial Personality Disorder↗

PubMed2006

Patterns of practice in mental health courts: A national survey.

Mental health courts (MHCs) represent an important new development at the interface of the criminal justice and mental health systems. MHCs are criminal courts for persons with mental illness that were in part created to divert this population from jail/prison into community treatment. MHCs are proliferating rapidly despite limited knowledge regarding their characteristics or their efficacy. We surveyed the entire population of adult MHCs in the United States, n = 90. In the past 8 years, MHCs have been created in 34 states, with an aggregate current caseload of 7,560 clients in MHCs nationally. Most courts (92%) reported using jail as a sanction for noncompliance, if only rarely. Further, jail sanction use was significantly predicted by increased judicial supervision and number of felons in the court. Implications for MHCs and social monitoring are discussed.

Humans↗

PubMed2006

Assessing gaps between policy and practice in Medicaid disenrollment of jail detainees with severe mental illness.

OBJECTIVE: This prospective cohort study in two large metropolitan jail systems examined whether Medicaid disenrollment policies for persons detained in jail were enforced. The extent to which persons with severe mental illness lost their Medicaid benefits while detained was determined. METHODS: Mailed questionnaires to state Medicaid directors in 2000 yielded a 95 percent response rate. Directors responded to questions about procedures that are followed when enrollees become inmates in public institutions. In addition, community mental health service records, jail detention records, and Medicaid enrollment records were linked in King County (Seattle) and in Pinellas County (Clearwater and St. Petersburg), Florida, to identify persons with severe mental illness who were incarcerated at any time during a two-year period (1996-1998 in King County and 1998-2000 in Pinellas County). The samples consisted of 1,816 persons representing 4,482 detentions in King County and 1,210 persons representing 2,878 detentions in Pinellas County. Detentions were used as the unit of analysis to determine how often Medicaid disenrollment occurred during jail incarceration. RESULTS: The stated policy in many states, including Florida and Washington, is to terminate Medicaid benefits upon incarceration, but termination occurred for only 3 percent of the detainees enrolled in Medicaid in each county. In both counties, in 97 percent of the detentions, persons who had Medicaid at entry also had it upon release. In both counties, the 3 percent who lost Medicaid while jailed had longer jail stays (three to five months compared with 16 to 30 days). CONCLUSIONS: Stated policies do not align with actual Medicaid disenrollment of persons with severe mental illness who become incarcerated. In most instances, short jail stays allowed detainees with severe mental illness to retain their Medicaid benefits.

Adult↗

PubMed2006

Medicaid enrollment and mental health service use following release of jail detainees with severe mental illness.

OBJECTIVE: This study assessed the extent to which Medicaid enrollment increased access to and use of services by persons with severe mental illness after their release from jail. METHODS: A prospective cohort design was used that linked administrative data from several agencies in two large urban areas: King County (Seattle) from 1996 to 1998 and Pinellas County (Clearwater and St. Petersburg), Florida, from 1998 to 2000. Access to and use of community mental health services within 90 days after release from jail was examined, depending on whether persons were enrolled in Medicaid at the time of their release. All analyses were based on detentions, rather than unique persons. The effects of Medicaid status (enrolled or not enrolled) on four dependent variables (probability of use, days to first service, number of services used, and rate of service use) were estimated separately for each county. RESULTS: A total of 1,210 persons who had 2,878 detentions were identified in Pinellas County: 2,215 of these detentions represented persons with Medicaid and 663 represented those without Medicaid. For King County, the corresponding numbers were 1,816 persons and 4,482 detentions: 2,752 of these detentions represented persons with Medicaid and 1,730 represented those without Medicaid. In both counties, those who had Medicaid at the time of their release were more likely to use services (p < .001), accessed community services more quickly (p < .001), and received more days of services (p < .001) than those without Medicaid. CONCLUSIONS: Medicaid enrollment enhanced receipt of community services after jail release in these two large urban counties. These are the best currently available data, and the data suggest that efforts to enroll persons with severe mental illness in Medicaid and ensure enrollment upon jail release will improve their access to and receipt of community-based services after release.

Adult↗

PubMed2006

Use of the criminal justice system to leverage mental health treatment: effects on treatment adherence and satisfaction.

In efforts to divert persons with mental illness from jails and prisons, the option of community mental health treatment in lieu of incarceration is sometimes offered. In addition, community treatment can be mandated, or "leveraged," as a condition of probation or parole. However, little is known about the characteristics and attitudes of persons who are and who are not leveraged into community mental health treatment via the criminal justice (CJ) system. In the present study, over 1,000 outpatients with mental disorders were queried about their experiences with CJ leverages, as well as their clinical and treatment histories. Persons who had experienced at least one form of CJ leverage were more likely to be younger and male and to have more hospitalizations than persons who had never experienced a CJ leverage. However, leverage experience was not associated with treatment compliance and satisfaction, or perceptions of coercion and mandate efficacy, particularly when demographic characteristics were considered.

Adolescent↗

PubMed2005

Assessing the effectiveness of jail diversion programs for persons with serious mental illness and co-occurring substance use disorders.

In recent years, jail diversion programs for people with serious mental illness and co-occurring substance use disorders have received increasing attention and have rapidly grown in number. Previous studies suggest that jail diversion programs have the potential to achieve positive outcomes. The present study reports findings from 6 jail diversion programs (3 pre-booking and 3 post-booking) participating in a federally-funded research initiative to assess the effectiveness of jail diversion programs for people with co-occurring disorders. Diverted and non-diverted groups were compared on self-reported outcomes at 12 months following diversion. The findings suggest that jail diversion reduces time spent in jail without increasing the public safety risk, while linking participants to community-based services. Jail diversion costs and the implications of these results for jail diversion programs and future research are discussed.

Adult↗

PubMed2005

From referral to disposition: case processing in seven mental health courts.

The number of mental health courts in the United States is rapidly increasing, from one in 1997 to nearly 100 in 2004. However, to date there is comparatively little research regarding these specialty courts. The present study reports data on the referral and disposition decision-making processes of seven mental health courts. Information on all referrals to the seven courts over a three-month period was gathered. Results show that, in comparison with individuals involved in the criminal justice system, mental health court clients are more likely to be older, White, and women than individuals in the general criminal justice system. Furthermore, this over-representation occurs at the point of referral, rather than at the point of the court's decision to accept or reject a referral. In addition, the length of time from referral to diversion is much longer in these mental health courts than in other types of diversion programs. Implications of these findings are discussed.

Adult↗

PubMed2005

Use of leverage to improve adherence to psychiatric treatment in the community.

OBJECTIVES: A variety of tools are being used as leverage to improve adherence to psychiatric treatment in the community. This study is the first to obtain data on the frequency with which these tools are used in the public mental health system. Patients' lifetime experience of four specific forms of leverage-money (representative payee or money handler), housing, criminal justice, and outpatient commitment-was assessed. Logistic regression was used to examine associations between clinical and demographic characteristics and receipt of different types of leverage. METHODS: Ninety-minute interviews were conducted with approximately 200 adult outpatients at each of five sites in five states in different regions of the United States. RESULTS: The percentage of patients who experienced at least one form of leverage varied from 44 to 59 percent across sites. A fairly consistent picture emerged in which leverage was used significantly more frequently for younger patients and those with more severe, disabling, and longer lasting psychopathology; a pattern of multiple hospital readmissions; and intensive outpatient service use. Use of money as leverage ranged from 7 to 19 percent of patients; outpatient commitment, 12 to 20 percent; criminal sanction, 15 to 30 percent; and housing, 23 to 40 percent. CONCLUSIONS: Debates on current policy emphasize only one form of leverage, outpatient commitment, which is much too narrow a focus. Attempts to leverage treatment adherence are ubiquitous in serving traditional public-sector patients. Research on the outcomes associated with the use of leverage is critical to understanding the effectiveness of the psychiatric treatment system.

Adult↗

PubMed2005

An actuarial model of violence risk assessment for persons with mental disorders.

OBJECTIVES: An actuarial model was developed in the MacArthur Violence Risk Assessment Study to predict violence in the community among patients who have recently been discharged from psychiatric facilities. This model, called the multiple iterative classification tree (ICT) model, showed considerable accuracy in predicting violence in the construction sample. The purpose of the study reported here was to determine the validity of the multiple ICT model in distinguishing between patients with high and low risk of violence in the community when applied to a new sample of individuals. METHODS: Software incorporating the multiple ICT model was administered with independent samples of acutely hospitalized civil patients. Patients who were classified as having a high or a low risk of violence were followed in the community for 20 weeks after discharge. Violence included any battery with physical injury, use of a weapon, threats made with a weapon in hand, and sexual assault. RESULTS: Expected rates of violence in the low- and high-risk groups were 1 percent and 64 percent, respectively. Observed rates of violence in the low- and high-risk groups were 9 percent and 35 percent, respectively, when a strict definition of violence was used, and 9 percent and 49 percent, respectively, when a slightly more inclusive definition of violence was used. These findings may reflect the "shrinkage" expected in moving from construction to validation samples. CONCLUSIONS: The multiple ICT model may be helpful to clinicians who are faced with making decisions about discharge planning for acutely hospitalized civil patients.

Actuarial Analysis↗

PubMed2005

Validation of the brief jail mental health screen.

OBJECTIVE: Jails have a substantial legal obligation to provide health and mental health care for inmates; yet screening procedures across American jails are highly variable. Currently, no valid, practical, standardized tool is available. The study reported here sought to validate a revision of the Referral Decision Scale (RDS)--the Brief Jail Mental Health Screen (BJMHS)--which provides an even briefer and more practical tool for use in jails. METHODS: Valid BJMHS data were collected in four jails (two in Maryland and two in New York) from 10,330 detainees. A total of 357 detainees were also administered the Structured Clinical Interview for DSM-IV (SCID) for standardized clinical cross-validation: 125 detainees (74 men and 51 women) who were classified as referrals for further mental health assessment on the basis of BJMHS and 232 detainees (137 men and 95 women) who were not classified as referrals. RESULTS: The BJMHS takes an average of 2.5 minutes to administer. It correctly classified 73.5 percent of males but only 61.6 percent of females on the basis of SCID diagnoses. Overall, the BJMHS identified 11.3 percent of screened detainees for further mental health assessment. CONCLUSIONS: The BJMHS is a practical, efficient tool that jail correction officers can give male detainees on intake screening. However, the screen has an unacceptably high false-negative rate for female detainees.

Adult↗

PubMed2003

Perceived coercion at hospital admission and adherence to mental health treatment after discharge.

The authors investigated whether mental health inpatients' perceptions of coercion were associated with later treatment adherence. Psychiatric inpatients receiving acute care at three sites were interviewed during their hospitalization and up to five times after discharge. Patients' perceptions of coercion were measured at admission. Adherence to medication and clinical treatment was measured every ten weeks for one year after discharge. Among the 825 patients who had a perceived coercion score and ten-week follow-up data and who reported that outpatient treatment was prescribed, perceived coercion scores were not associated with treatment adherence. The authors concluded that perceived coercion neither increases nor decreases psychiatric inpatients' medication adherence or use of treatment services after discharge.

Adolescent↗

PubMed2003

Perceived coercion and treatment adherence in an outpatient commitment program.

The authors investigated whether mental health inpatients' perceptions of coercion were associated with postdischarge treatment adherence. Patients eligible for New York's outpatient commitment program were interviewed and their perceptions of coercion measured during hospitalization and at one, five, and 11 months after discharge. Medication and clinical treatment adherence were measured at the three postdischarge interviews. Among the 117 participants who completed at least one follow-up interview, higher perceived coercion scores were correlated with greater self-reported adherence to clinical treatment at the one-month follow-up but not with participants' greater self-reported adherence at subsequent follow-ups or with providers' ratings of participants' adherence. Perceived coercion scores were positively correlated with participants' self-reported adherence to injected medications.

Aftercare↗

PubMed2002

Successful program maintenance when federal demonstration dollars stop: the ACCESS program for homeless mentally ill persons.

A major issue that has long dogged federal human services demonstration programs is the perception that when federal dollars end, the programs end-regardless of any proven successes. Access to Community Care and Effective Services and Supports (ACCESS) was a 5-year federal demonstration project to foster partnerships between service providers for homeless people with serious mental illness and co-occurring substance abuse disorders; and to identify effective, replicable systems integration strategies. After federal funding ended, research teams visited the ACCESS sites to determine which project elements remained and which strategies were used by the sites to continue ACCESS. This article describes ACCESS services and systems integration activities retained by the sites, new funding streams, and strategies used to obtain continued funding.

Community Mental Health Services↗

PubMed2002

The use of criminal charges and sanctions in mental health courts.

OBJECTIVE: This study sought to describe the use of criminal charges, sanctions (primarily jail), and other strategies mental health courts use to mandate adherence to community treatment, and in doing so to elaborate on earlier descriptions of such courts. METHODS: Telephone interviews were conducted with staff of four mental health courts, located in Santa Barbara, California; Clark County, Washington; Seattle, Washington; and Marion County, Indiana. RESULTS: Mental health courts use one or more of three approaches to leverage the disposition of criminal charges to mandate adherence to community treatment: preadjudication suspension of prosecution of charges, postplea strategies that suspend sentencing, and probation. In no case are criminal charges dropped before the defendant becomes involved with the mental health court program. Each dispositional strategy includes adherence to community treatment as a condition. Courts report a wide variety of sanctions for failure to adhere to court-ordered conditions. CONCLUSIONS: Mental health courts use various creative methods of disposition of criminal charges to mandate adherence to community treatment. In contrast to drug courts, in which the use of jail and other sanctions for nonadherence is common, most mental health courts report rarely or occasionally using jail in this way.

Commitment of Persons with Psychiatric Disorders↗

PubMed2002

Integration of service systems for homeless persons with serious mental illness through the ACCESS program. Access to Community Care and Effective Services and Supports.

OBJECTIVE: The aim of this study was to evaluate the first of the two core questions around which the ACCESS (Access to Community Care and Effective Services and Supports) evaluation was designed: Does implementation of system-change strategies lead to better integration of service systems? METHODS: The study was part of the five-year federal ACCESS service demonstration program, which sought to enhance integration of service delivery systems for homeless persons with serious mental illness. Data were gathered from nine randomly selected experimental sites and nine comparison sites in 15 of the nation's largest cities on the degree to which each site implemented a set of systems integration strategies and the degree of systems integration that ensued among community agencies across five service sectors: mental health, substance abuse, primary care, housing, and social welfare and entitlement services. Integration was measured across all interorganizational relationships in the local service networks (overall systems integration) and across relationships involving only the primary ACCESS grantee organization (project-centered integration). RESULTS: Contrary to expectations, the nine experimental sites did not demonstrate significantly greater overall systems integration than the nine comparison sites. However, the experimental sites demonstrated better project-centered integration than the comparison sites. Moreover, more extensive implementation of strategies for system change was associated with higher levels of overall systems integration as well as project-centered integration at both the experimental sites and the comparison sites. CONCLUSIONS: The ACCESS demonstration was successful in terms of project-centered integration but not overall system integration.

Community Mental Health Services↗