Clinical Case Consultation with Specialty Mental Health Probation Officers: Specification of a Key Implementation Strategy

Background: Persons with mental illnesses are disproportionately represented in the criminal justice system and have higher rates of recidivism, infractions, and probation violations compared to those without mental illnesses. Specialty mental health probation (SMHP) –which includes reduced caseload sizes, exclusive caseloads of probationers with mental illness, ongoing officer training in mental health, a problem-solving supervision approach, and greater engagement with community mental health providers –has emerged as a promising practice. Although widely disseminated, little is known about how to implement SMHP with fidelity.  To advance the literature in this area, we present findings from a hybrid randomized trial and implementation study to describe and specify a replicable implementation strategy –clinical case consultation for SMHP officers– that enhances the uptake of three key components of the model: ongoing training, problem-solving orientation, and contacts with resource providers.

Methods: We collected data during clinical case consultation meetings between a licensed clinical social worker and four SMHP officers. These data contained information about SMHP caseload characteristics, SMHP officer challenges supervising probationers with mental illnesses, and action steps suggested by the clinical consultant. We selected a random sample (n=20) of case notes from 81 case consultations. Two research team members analyzed the notes using a grounded theory approach to identify themes. Inter-rater agreement was 80.85% as measured by Cohen’s Kappa Coefficient. From these data, we specified clinical case consultation procedures using an established conceptual framework from Proctor et al. (2013), which consists of seven domains: actor, action, target, justification, outcome, dosage, and temporality.

Results: Our data primarily addressed three of the seven domains of the specification framework: temporality, dose, and action. In terms of temporality and dose, monthly case consultation began within the first two months of SMHP implementation and each session lasted an average of 43 minutes (SD=13.3). Case consultation action steps focused on three areas: education and training (e.g., information about medication and mental health symptoms) resource connections (e.g., contacts with community supports), and supporting the officers (e.g., officer wellbeing, role balance). Most of the action steps targeted education and resources and were consistent across urban and rural counties.

Conclusions and Implications: We used empirical data to apply an established framework for specifying an implementation strategy intended to enhance the uptake of three core components of the SMHP model. Our findings have clear implications for social work practice, policy, and research and provide guidelines for clinical social workers involved in case consultation with probation officers and others who implement interventions spanning the criminal justice and mental health systems. Our study also lays the groundwork for testing the effectiveness of this implementation strategy; for example, comparing intervention fidelity between settings that use clinical case consultation and those that do not. Further, the use of implementation strategies enhances the uptake of interventions such as SMHP and can be used to aid in dissemination. By specifying clinical case consultation using an established framework, this study offers criminal justice and mental health authorities and policymakers a replicable mechanism for enhancing SMHP fidelity and bringing it to scale.