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Lamberti JS, Weisman RL, Cerulli C, Williams GC, Jacobowitz DB, Mueser KT, Marks PD, Strawderman RL, Harrington D, Lamberti TA, Caine ED. A Randomized Controlled Trial of the Rochester Forensic Assertive Community Treatment Model. Psychiatr Serv 2017; 68:1016-1024. [PMID: 28566028 PMCID: PMC7369621 DOI: 10.1176/appi.ps.201600329] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Forensic assertive community treatment (FACT) is an adaptation of the assertive community treatment model and is designed to serve justice-involved adults with serious mental illness. This study compared the effectiveness of a standardized FACT model and enhanced treatment as usual in reducing jail and hospital use and in promoting engagement in outpatient mental health services. METHODS Seventy adults with psychotic disorders who were arrested for misdemeanor crimes and who were eligible for conditional discharge were recruited from the Monroe County, New York, court system. Participants were randomly assigned to receive either FACT (N=35) or enhanced treatment as usual (N=35) for one year. Criminal justice and mental health service utilization outcomes were measured by using state and county databases. RESULTS Forty-nine participants (70%) completed the full one-year intervention period. Nineteen (27%) were removed early by judicial order, one was removed by county health authorities, and one died of a medical illness. Intent-to-treat analysis for all 70 participants showed that those receiving the FACT intervention had fewer mean±SD convictions (.4±.7 versus .9±1.3, p=.023), fewer mean days in jail (21.5±25.9 versus 43.5±59.2, p=.025), fewer mean days in the hospital (4.4±15.1 versus 23.8±64.2, p=.025), and more mean days in outpatient mental health treatment (305.5±92.1 versus 169.4±139.6, p<.001) compared with participants who received treatment as usual. CONCLUSIONS The Rochester FACT model was associated with fewer convictions for new crimes, less time in jail and hospitals, and more time in outpatient treatment among justice-involved adults with psychotic disorders compared with treatment as usual.
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Affiliation(s)
- J Steven Lamberti
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Robert L Weisman
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Catherine Cerulli
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Geoffrey C Williams
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - David B Jacobowitz
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Kim T Mueser
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Patricia D Marks
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Robert L Strawderman
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Donald Harrington
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Tara A Lamberti
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
| | - Eric D Caine
- Dr. Lamberti, Dr. Weisman, Dr. Cerulli, Mr. Jacobowitz, and Dr. Caine are with the Department of Psychiatry, Dr. Williams is with the Department of Medicine and the Department of Clinical and Social Sciences in Psychology, Dr. Strawderman and Mr. Harrington are with the Department of Biostatistics and Computational Biology, and Ms. Lamberti is with the School of Nursing, all at the University of Rochester Medical Center, Rochester, New York. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Judge Marks (ret.) is with the Monroe County Courts, Rochester, New York
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Croake S, Brown JD, Miller D, Darter N, Patel MM, Liu J, Scholle SH. Follow-Up Care After Emergency Department Visits for Mental and Substance Use Disorders Among Medicaid Beneficiaries. Psychiatr Serv 2017; 68:566-572. [PMID: 28093060 DOI: 10.1176/appi.ps.201500529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined whether characteristics of Medicaid beneficiaries were associated with receipt of follow-up care after discharge from the emergency department (ED) following a visit for mental or substance use disorders. METHODS Medicaid fee-for-service claims from 15 states and the District of Columbia in 2008 were used to calculate whether adults received follow-up (seven and 30 days) after being discharged from the ED following a visit for mental disorders (N=31,952 discharges) or substance use disorders (N=13,337 discharges). Random-effects logistic regression was used to model the odds of receiving follow-up as a function of beneficiary characteristics. RESULTS Receipt of follow-up varied widely across states and by beneficiary characteristics. The odds of seven- and 30-day follow-up after mental health ED discharges were lower among males; African Americans versus whites; and beneficiaries who qualified for Medicaid on the basis of income rather than disability, beneficiaries with depression and other mood disorders compared with other psychiatric diagnoses, and (at seven-day follow-up) beneficiaries who lived in rural versus metropolitan areas. In contrast, the odds of follow-up after substance use disorder ED discharges were lower among whites (seven-day follow-up) and among beneficiaries who qualified for Medicaid on the basis of disability rather than income, who were diagnosed as having drug use disorders rather than alcohol use disorders, or who lived in metropolitan versus suburban areas (seven- and 30-day follow-ups). CONCLUSIONS State Medicaid programs have an opportunity to improve follow-up after ED visits for mental and substance use disorders, perhaps by focusing on groups of beneficiaries who are less likely to receive follow-up.
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Affiliation(s)
- Sarah Croake
- Ms. Croake, Dr. Brown, Mr. Miller, and Mr. Darter are with Mathematica Policy Research, Washington, D.C., and Ann Arbor, Michigan (e-mail: ). Mr. Patel, Dr. Liu, and Dr. Scholle are with the National Committee for Quality Assurance, Washington, D.C., where Dr. Scholle is with the Department of Research and Analyses
| | - Jonathan D Brown
- Ms. Croake, Dr. Brown, Mr. Miller, and Mr. Darter are with Mathematica Policy Research, Washington, D.C., and Ann Arbor, Michigan (e-mail: ). Mr. Patel, Dr. Liu, and Dr. Scholle are with the National Committee for Quality Assurance, Washington, D.C., where Dr. Scholle is with the Department of Research and Analyses
| | - Dean Miller
- Ms. Croake, Dr. Brown, Mr. Miller, and Mr. Darter are with Mathematica Policy Research, Washington, D.C., and Ann Arbor, Michigan (e-mail: ). Mr. Patel, Dr. Liu, and Dr. Scholle are with the National Committee for Quality Assurance, Washington, D.C., where Dr. Scholle is with the Department of Research and Analyses
| | - Nathan Darter
- Ms. Croake, Dr. Brown, Mr. Miller, and Mr. Darter are with Mathematica Policy Research, Washington, D.C., and Ann Arbor, Michigan (e-mail: ). Mr. Patel, Dr. Liu, and Dr. Scholle are with the National Committee for Quality Assurance, Washington, D.C., where Dr. Scholle is with the Department of Research and Analyses
| | - Milesh M Patel
- Ms. Croake, Dr. Brown, Mr. Miller, and Mr. Darter are with Mathematica Policy Research, Washington, D.C., and Ann Arbor, Michigan (e-mail: ). Mr. Patel, Dr. Liu, and Dr. Scholle are with the National Committee for Quality Assurance, Washington, D.C., where Dr. Scholle is with the Department of Research and Analyses
| | - Junqing Liu
- Ms. Croake, Dr. Brown, Mr. Miller, and Mr. Darter are with Mathematica Policy Research, Washington, D.C., and Ann Arbor, Michigan (e-mail: ). Mr. Patel, Dr. Liu, and Dr. Scholle are with the National Committee for Quality Assurance, Washington, D.C., where Dr. Scholle is with the Department of Research and Analyses
| | - Sarah Hudson Scholle
- Ms. Croake, Dr. Brown, Mr. Miller, and Mr. Darter are with Mathematica Policy Research, Washington, D.C., and Ann Arbor, Michigan (e-mail: ). Mr. Patel, Dr. Liu, and Dr. Scholle are with the National Committee for Quality Assurance, Washington, D.C., where Dr. Scholle is with the Department of Research and Analyses
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