Research That Matters (January 17 - 20, 2008)

Purpose: Jail diversion programs can offer a valuable opportunity for individuals with mental illness to re-establish community ties, rather than revolving through the criminal justice system (Draine & Solomon, 1999), but programs to encourage enhanced community tenure for those with co-occurring substance use that have criminal justice histories have received little attention in empirical research and literature. In response, we conducted a randomized study, based on a theoretical framework of citizenship, involving individuals with co-occurring mental illness and substance use disorders who were part of a jail-diversion program. This concept of citizenship is based on the benefits of having access to the rights, roles, responsibilities, and resources that society offers to people through public and social institutions and the informal life of communities (Rowe, 1999; Rowe & Baranoski, 2000). We hypothesized that those receiving the citizenship intervention along with standard services that included jail diversion, would show lower levels of alcohol use and criminal charges over time compared to those receiving standard services with jail diversion only. The intervention involved twice-weekly two-hour classes of six to ten participants over an eight-week period, and an assignment of a peer mentor to each participant. The primary objectives of the citizenship classes and peer support were to enhance participants' knowledge of available community resources, their problem-solving and other life skills for daily living, and their ability to establish supportive social networks based on mutual trust and shared interests. Methods: To evaluate these hypotheses we conducted an investigation using a 2 × (3) prospective longitudinal randomized clinical trial design with two levels of intervention (citizenship intervention plus standard services [experiment], and standard services only [control]) and three evaluation periods (baseline, 6 and 12 months). Assessment procedures included interviews with participants concerning their alcohol and drug use and review of a public access state database on criminal charges. The sample included 108 adults with serious mental illness; 70% had co-occurring alcohol and/or substance abuse disorders; 68% were male; and 57% were African American. A mixed models regression analysis was used to assess hypotheses. In addition, qualitative interviews were done with peer mentors and post-intervention focus groups with study participants and peer mentors. Results: The experimental group showed significantly reduced alcohol use as compared to the control group. Further, results showed a significant group by time interaction, where alcohol use decreased over time in the experimental, and increased in the control group. Arrests decreased significantly across assessment periods in both groups. Analysis of the qualitative interviews and focus groups suggest that certain characteristics of the intervention not only reduced participants' use of alcohol, but may also contribute to other, longer-term benefits. Chiefly, these characteristics are embedded in the three components of the intervention: peer mentorship, citizenship classes, and valued role projects. Implications: Community-oriented group support and learning combined with peer mentor support may encourage decreased alcohol use and fewer criminal justice contacts. Incorporating social work values and principles, the Citizenship concept and intervention model may be useful for social workers working for this population of individuals.