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The Role of Probation in Forensic Assertive Community Treatment

by J. Steven Lambert, Alison Deem, Robert L. Weisman, and Casey LaDuke (2011). "The Role of Probation in Forensic Assertive Community Treatment." Psychiatric Services, 62(4): 418-421.

Forensic assertive community treatment (FACT) was adapted from assertive community treatment (ACT) as a bridge between criminal justice and mental health. Given the increased visibility of mental health populations, and the interdisciplinary development of these fields, it is not surprising that criminal justice and mental health practitioners are working together more closely. In this article, spearheaded by researchers from the Department of Psychiatry at the University of Rochester Medical Center, Steven Lamberti, Alison Deem, Robert Weisman, and Casey LaDuke conduct a national survey of probation department collaboration with FACT programs.

ACT is widely recognized as a standard-bearer for intervening with persons afflicted with schizophrenia, bipolar disorder, and other forms of severe mental illness. Historically, however, probation officers have not been an integral part of this model of care. But severe mental illness is prevalent for offenders on probation, including high levels of mania and psychosis. Typically offenders with mental illness do poorly on probation, so probation officers routinely face the challenge of appropriately integrating mental health services into their criminal justice practice. One response has been specialized probation caseloads, which have had mixed levels of success. On the other hand, ACT, Lamberti et al. note, has had mixed results in terms of reducing arrest and incarceration rates. Accordingly, probation officers and mental health workers have something to offer, and perhaps gain, from one another, familiarity with the challenge of reducing recidivism and the availability of mental health services.

However, criminal justice and mental health officers have different goals, methods, and values. Some years ago, social workers Phyllis Solomon and Jeffrey Draine, in a 1995 article in Health and Social Work, found that incarceration rates increased when probation officers worked with ACT teams. In this article, Lamberti et al. examine the barriers to, and the effectiveness of, collaboration between FACT-based probation officers and mental health workers. Between October 2007 and June 2009, a two-phase survey was conducted first with all 676 members of the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD). The survey inquired about ACT teams with clients that satisfied three FACT screening criteria: a history of arrest and incarceration, referrals from one or more criminal justice agencies, and working relationships with one or more criminal justice agencies.  Using the Dartmouth Assertive Community Treatment Scale, telephone interviews were conducted to assess these programs' fidelity to ACT components such as in vivo delivery service, 1:10 staff-to-client ratio, 1:100 psychiatrist-to-client ratio, 24-hour availability for crisis services, time-unlimited services, and the availability of a staff substance abuse counselor. The second phase of this study involved locating FACT programs where probation officers attended daily team meetings 20% of the time, or at least once a week. Telephone interviews were used to gather information about these probation-involved FACT teams.

The survey of NACBHDD members had a high rate of response (90%, or 607 out of 676): 61 programs were identified; 27 met FACT criteria; 15 (56%) of these had close probation working relationships; 13 (87%) of these started after 1998. Twelve (80%) of the 15 programs required a history of misdemeanor arrests; 11 (73%) admitted persons with violent offenses. Only two programs reported using standardized risk assessment tools; nine programs had a full-time probation officer, who generally served the functions of court liaison, collector of collateral information, drug tester, and community outreach worker. Probation officers typically worked only with offenders serving a probation sentence. Four programs observed that probation officers also helped develop clinical information.

A high level of agreement existed between probation officers and mental health clinicians on the use of legal sanctions. Probation involvement was viewed as positive or very positive in 13 programs (90%). Only one program reported that probation officer presence resulted in a higher risk or rearrest or reincarceration. The most commonly cited barrier to collaboration was the difference philosophy or approaches of probation officers and mental health clinicians. Lambert et al. note, "Program representatives generally described clinicians as being more health oriented and diplomatic with patients, whereas they described probation officers as more public safety oriented and directive with patients. One team struggled to keep role clear yet integrated; the mental health staff took on a monitoring role, and the probation officer functioned more as a case manager."

Lamberti et al. conclude, "Because FACT teams target patients who are involved in the criminal justice system, they are an ideal point of interface for specialty probation. This partnership appears to be mutually beneficial. FACT clinicians can gain access to legal leverage to promote treatment adherence, and probation officers can access therapeutic alternatives to the use of punitive sanctions in managing probation violations. The finding that FACT program representatives view probation involvement as helpful is consistent with the conceptual framework that combining legal leverage with accessible care that targets recidivism risj factors will reduce recidivism. However, the findings that only two of 15 programs used standardized risk assessment tools is noteworthy given the high prevalence of recidivism factors among FACT patients. These findings suggest that FACT programs can benefit by further incorporating interventions that will both identify and address risk factors for criminal recidivism."

For further information, contacts Dr. Lamberti at the Department of Psychiatry, University of Rochester Medical center, 300 Crittenden Blvd., Rochester, NY 14642, (e-mail) lamberti@urmc.rochester.edu




Posted Fri, Aug 26 2011 2:22 PM by Tracey Vessels

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