CORRELATES OF INTERORGANIZATIONAL SERVICE COORDINATION IN COMMUNITY CORRECTIONS

Implementation Strategy Fidelity and Organizational Outcomes in a Randomized Trial: Implications for Reentry from Corrections to Community Treatment

Background: This study examined fidelity of implementation strategies used in an organizational process improvement intervention (OPII) designed to improve evidence-based practices related to assessments for drug-involved clients exiting incarceration. Leadership was studied as a moderating factor between fidelity and outcomes. Methods: A mixed-method cluster randomized design was used to randomize 21 sites to early- or delayed-start within 9 research centers. Parent study protocol was reviewed to develop fidelity constructs (i.e., responsiveness, dose, quality, adherence). Outcomes were site-level success in achieving goals and objectives completed during the OPII (e.g., percent goals achieved). Correlations, analyses of covariance, regressions and moderation analyses were performed. Qualitative interviews assessed facilitators/barriers to implementation. Results: Fidelity constructs related to outcomes. No differences were found in fidelity by early or delayed condition. At low levels of leadership, high staff responsiveness (i.e., engagement in the OPII) related to poorer outcome. Conclusions: It is important to consider contextual factors (e.g., leadership) that may influence implementation strategy fidelity when deploying evidence-based practices. Findings are relevant to researchers, clinicians, administrators and policy makers, and suggest that goal completion during implementation of evidence-based practices requires monitoring of leadership competence, fidelity to implementation strategies (i.e., staff responsiveness to strategies) and attendance to goal importance.

The comparative effectiveness of Core versus Core+Enhanced implementation strategies in a randomized controlled trial to improve substance use treatment receipt among justice-involved youth

BACKGROUND

Most justice-involved youth are supervised in community settings, where assessment and linkage to substance use (SU) treatment services are inconsistent and fragmented. Only 1/3 of youth with an identified SU need receive a treatment referral and even fewer initiate services. Thus, improving identification and linkage to treatment requires coordination across juvenile justice (JJ) and behavioral health (BH) agencies. The current study examines the comparative effectiveness of two bundled implementation intervention strategies for improving SU treatment initiation, engagement, and continuing care among justice-involved youth supervised in community settings. Exploration, Preparation, Implementation, Sustainment (EPIS) served as the conceptual framework for study design and selection/timing of implementation intervention components, and the BH Services Cascade served as the conceptual and measurement framework for identifying and addressing gaps in service receipt.

METHODS

Part of a larger Juvenile-Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) Cooperative, this study involved a multisite, cluster-randomized control trial where sites were paired then randomly assigned to receive Core (training teams on the BH Services Cascade and data-driven decision making; supporting goal selection) or Core+Enhanced (external facilitation of implementation teams) intervention components. Youth service records were collected from 20 JJ community supervision agencies (in five states) across five study phases (baseline, pre-randomization, early experiment, late experiment, maintenance). Implementation teams comprised of JJ and BH staff collaboratively identified goals along the BH Cascade and used data-driven decision-making to implement change.

RESULTS

Results suggest that Core intervention components were effective at increasing service receipt over time relative to baseline, but differences between Core and Core+Enhanced conditions were non-significant. Time to service initiation was shorter among Core+Enhanced sites, and deeper Cascade penetration occurred when external facilitation (of implementation teams) was provided. Wide variation existed in the degree and nature of change across service systems.

CONCLUSIONS

Findings demonstrate the criticality of early EPIS phases, demonstrating that strategies provided during the formative exploration and preparation phases produced some improvement in service receipt, whereas implementation-focused activities produced incremental improvement in moving youth farther along the Cascade.

Using implementation interventions and peer recovery support to improve opioid treatment outcomes in community supervision: Protocol

OBJECTIVE

The purpose is to determine whether a facilitated local change team (LCT) intervention improves linkage to medication for opioid use disorder (MOUD) and implementation outcomes, and whether participant-level outcomes are further enhanced by use of peer support specialists (PSS).

METHODS

This Type 1 hybrid implementation-effectiveness study involves a pre-post design (implementation study) followed by a randomized trial of PSS (effectiveness study). Participants are at least 114 justice and service staff from 7 sites in three states: probation officers, community treatment providers, a supervisor from each agency, and key stakeholders. The study will recruit up to 680 individuals on probation from seven adult community probation offices; eligible individuals will be recently committed, English speakers, with opioid use disorder (OUD). Core Implementation Study: The study will use the exploration, preparation, implementation, sustainability (EPIS) framework to guide system-change through facilitated LCTs of probation and community treatment staff given a core set of implementation strategies to set goals. The study will collect program-level and staff survey data at the end of each EPIS stage. Implementation outcomes: Organizational engagement in MOUD (primary), plus changes in staff knowledge/attitudes and organizational outcomes (secondary). Effectiveness Study of PSS: After completing implementation, the study will randomize adults on probation to receive PSS vs. treatment as usual, with assessments at baseline, 3, 6 and 12 months. Effectiveness outcomes include participant engagement in MOUD (primary), probation revocation, illicit opioid use, and overdoses. Other aims include identifying barriers and facilitators, and cost-benefit analysis of PSS. Adaptations in response to COVID-19 included moving many procedures to remote methods.

Critical Factors Influencing Interorganizational Relationships Between Juvenile Probation and Behavioral Health Agencies

Although interorganizational relationships (IORs) are essential to the effective delivery of human services, very little research has examined relationships between juvenile justice agencies and behavioral health providers, and few studies have identified the most critical organizational and individual-level characteristics influencing IORs. Across 36 sites, juvenile probation officials (n = 458) and community behavioral health providers (n = 91) were surveyed about characteristics of their agencies, themselves, and IORs with each other. Generalized Linear Mixed Models were used to analyze the data. The strongest predictors included Perceived Organizational Support and individual Adaptability. Implications for research, theory and practice are discussed.

Probation Officers' and Supervisors' Perspectives on Critical Resources for Implementing Specialty Mental Health Probation

This paper presents the results of a qualitative study designed to explore and identify the resources that probation officers need to implement specialized mental health probation caseloads, a promising practice that enhances mental health treatment engagement and reduces recidivism among people with mental illnesses. Our research team conducted a directed content analysis guided by the Practical, Robust Implementation and Sustainability Model (PRISM) to analyze qualitative interviews with 16 specialty mental health probation officers and their supervising chiefs. Results indicated five components and resources related to multiple PRISM constructs: (1) meaningfully reduced caseload sizes (intervention design), (2) officers' ability to build rapport and individualize probation (organizational staff characteristics), (3) specialized training that is offered regularly (implementation and sustainability infrastructure), (4) regular case staffing and consultation (implementation and sustainability infrastructure), and (5) communication and collaboration with community-based providers (external environment). Agencies implementing specialized mental health probation approaches should pay particular attention to selecting officers and chiefs and establishing the infrastructure to implement and sustain specialty mental health probation.

Sex Offender Supervision: Communication, Training, and Mutual Respect Are Necessary for Effective Collaboration Between Probation Officers and Therapists

Developed with the goal of preventing recidivism, contemporary sex offender supervision models focus on collaboration between probation officers and therapists. This exploratory study used focus groups to examine the working relationships between probation officers and therapists from two large U.S. urban probation departments. Overall, both probation officers and therapists were quite positive about their working relationships; they valued each others' roles and agreed that regular, accurate, and timely communication occurred frequently. Not all relationships, however, were effective. Several probation officers and therapists expressed dissatisfaction with poor communication, conflicts between the goals of therapy and probation, a lack of resources, and deficits in the policies they needed to adequately implement components of their supervision model (the containment model). Our findings suggest ways to structure sexual offender supervision that integrate the distinct orientations of probation officers and therapists into a collaboration that promotes public safety and work well for all.

Daily stressors as antecedents, correlates, and consequences of alcohol and drug use and cravings in community-based offenders

Justice-involved individuals with alcohol and drug use problems reoffend at higher rates than their nonusing counterparts, with alcohol and drug use serving as an important vector to recidivism. At the daily level, exposure to stressors may exacerbate problematic alcohol and drug use; at the individual level, prior treatment experiences may mitigate substance use as individuals adapt to and learn new coping mechanisms. We conducted a daily diary study using Interactive Voice Response technology over 14 consecutive days with 117 men on probation or parole participating in a community-based treatment program (n = 860 calls) and referred to medication-assisted treatment. Participants reported daily stressors, craving for alcohol and illegal drugs, and use of alcohol and illegal drugs 1 time each day. Results of multilevel models showed significant day-to-day fluctuation in alcohol and drug craving and use. In concurrent models, increases in daily stressors were associated with increases in cravings and use of illegal drugs. Prior treatment experience modified many of these relationships, and additional lagged models revealed that those with less treatment experience reported an increase in next-day alcohol craving when they experienced increases in stressors on the previous day compared to those with more treatment experience. Collectively, these findings highlight the importance of tailoring treatment as a function of individual differences, including prior treatment experiences, and targeting daily stressors and subsequent cravings among justice-involved adults with alcohol and drug use problems. (PsycINFO Database Record

Developing effective interorganizational relationships between community corrections and community treatment providers

Weak service coordination between community corrections and community treatment agencies is a significant barrier in the diffusion of pharmacotherapy for treating opioid and alcohol use disorders. This analysis draws on qualitative interviews (n=141) collected in a multisite randomized trial to explore what probation/parole officers and treatment staff believe are the most critical influences on developing positive interorganizational relationships (IORs) between their respective agencies. Officers and treatment staff highlighted factors at both the individual and organizational level, with issues related to communication surfacing as pivotal. Findings suggest that future interventions consider developing shared interagency goals with input at all staff levels.