Session: A Randomized Controlled Trial and Implementation Study within Adult Corrections: How a Hybrid Effectiveness-Implementation Study Advances Practice, Policy, and Research (Society for Social Work and Research 22nd Annual Conference - Achieving Equal Opportunity, Equity, and Justice)

There are nearly 7 million adults are under correctional supervision and between 16% and 64% have a mental health condition. Justice-involved persons with mental illnesses have higher rates of infractions in jails and prisons, a greater number of probation violations, and poor adherence to medication and treatment. In addition, in many communities, the social safety net of services has eroded significantly over the last several years. Consequently, adults with severe mental illnesses in the criminal justice system get caught in a cycle of recidivism, homelessness, and hospitalization at great personal and social cost.

Community corrections (i.e., probation and parole) face the highest volume of adults with mental illnesses, where 800,000 to 1.3 million individuals with mental illnesses are under community supervision arrangements. Despite the large numbers of individuals with mental illnesses on probation, probation officers are not well trained or prepared to supervise this population and note significant supervision challenges, such as dealing with medication non-compliance, the shortage of community-based resources for probationers, probationers not understanding the terms of their supervision, inadequate housing, and a lack of social supports.

Specialty mental health probation (SMHP) has proliferated as a promising criminal justice response to addressing the unique challenges of supervising probationers with mental illnesses. Although there is some variability in the SMHP model, five key elements have emerged: (a) specialized caseloads in which all probationers have a mental illness; (b) reduced caseload size; (c) ongoing mental health training for officers; (d) a problem-solving supervision orientation; and (e) collaboration with internal and external resources to link probationers with supports.

As the evidence for SMHP builds, two significant limitations have emerged. First, no rigorous research studies (i.e., randomized controlled trials) have been conducted to examine the efficacy of a prototypical model of SMHP. Second, no studies have examined the implementation of prototypical SMHP, in general, and among rural and urban counties in particular. The lack of rigorous research on SMHP to support the evidence of its efficacy – coupled with the lack of information about implementation challenges, facilitators and strategies in urban and rural counties – impedes efforts to build the evidence base of SMHP and its high-fidelity dissemination.

Here, to address these limitations, we used a hybrid type I effectiveness-implementation study. This type of design examines intervention effectiveness in studies conducted within real-world settings and allows for the identification and specification of implementation strategies that will enhance the uptake and dissemination of interventions. The series of papers presented within this symposium report on: (a) results from a randomized controlled trial of SMHP; (b) challenges, facilitators, and strategies for implementation of SMHP; and (c) the specification of an implementation strategy aimed to enhance uptake of the model. Taken together, these papers illustrate the utility of a hybrid research design that can help to advance the research in order to decrease the amount of time it takes to bring effective practices to scale.