Engagement Processes in Model Programs for Prison Reentry for SMI

BACKGROUND AND PURPOSE: The overrepresentation of people with serious mental illnesses (SMI) in jails and prisons has propelled interest in service models to facilitate successful reentry transitions. The transition from prison, in particular, is fraught with risk for negative outcomes as drug overdose, suicide, and re-incarceration. Engaging former prisoners in mental health treatment is considered a necessary but not sufficient component of successful reentry, yet little research exists to guide efforts to maximize treatment engagement in a difficult-to-reach group that evinces many engagement barriers. In this presentation, we examine the engagement process in two programs, each representing an evidence-based practice for mental health which has been adapted to the context of prison reentry.  One model, Forensic Assertive Community Treatment (FACT), emphasizes a long-term wrap-around approach that seeks to maximize continuity of care by concentrating all services within one interdisciplinary team; the other, Critical Time Intervention (CTI), is a time-limited intervention that focuses upon linking clients to outside services and bolstering natural support systems.  METHODS: To examine crosscutting and divergent engagement practices, we analyze data from two qualitative studies, each of which was conducted in a newly developed treatment program, serving prisoners with mental illness being discharged from state prisons to urban communities.  Data sources across both studies include interviews with consumers (n=37), interviews with staff (n=10), field notes taken while observing treatment team meetings, and program records.  Data analyses were conducted using grounded dimensional analysis, which is a specific variant of grounded theory which adopts greater flexibility in sampling procedures.  RESULTS:  CTI and FACT programs each rely upon the provision of concrete, tangible resources as a key method of engaging clients, and each program provides intensive emotional support during the reentry transition.  Despite these similarities, the two models embody distinct cultures and rituals of reentry, exhibited in their approaches to the pre-release engagement phase, the transition out of prison, and the engagement of consumers in seeking mental health services post release.  The engagement efforts of the FACT team are more intensive and promote dependency of the client on the program for ongoing support, whereas the CTI team strategically limits service intensity to prevent the generation of dependency. Intensive engagement efforts maximize service continuity, but present unique problems of promoting independence and self-determination following initial engagement.  The less intensive approach emphasizes self-determination and capitalizes upon pre-existing client motivation, but is less effective when clients actively avoid contact with program staff.  The observed differences in approach stem from not only differences in the spirit and philosophy of each model, but also the disparate resources each team has as its disposal to employ in the pursuit of social influence strategies to promote engagement.   CONCLUSIONS AND IMPLICATIONS:  This study illuminates distinctions between two prominent engagement approaches used with justice-involved people with mental illness.  Research on the effectiveness of different engagement strategies for consumers with different treatment needs is a critical next step in understanding how to build more effective bridges to mental health services in the fragile transition from prison to community.