Center for Advancing Correctional Excellence, Schar School of Policy & Government, George Mason University, 4400 University Drive, 6D3, Fairfax, VA, USA.
Department of Criminal Justice, University of Central Florida, 12805 Pegasus Drive, Orlando, FL 32816, USA.
J Subst Use Addict Treat. 2024 Dec;167:209488. doi: 10.1016/j.josat.2024.209488. Epub 2024 Aug 22.
Justice-involved populations have dramatically higher rates of substance use disorders (SUD) and mental health disorders (MHD) compared to the general population. Despite high rates of SUD and MHD, treatment for this population is often limited and not evidence-based. The cascade of care model estimates drop-offs in the continuum of care from screening to identification of need, referral, care initiation, care engagement, and care completion. Recently, healthcare providers have utilized the cascade of care to improve the continuity of care for people with SUD and MHD in justice settings. The purpose of the current study is to 1) identify typologies that explain the proportion of new intakes that pass through each level of the cascade of care for SUD and MHD, and 2) describe agency-level factors that predict typology assignments and agency ability to assess client flow through the levels of the care cascade.
Using Latent Class Analysis, we classify 791 agencies serving justice-involved individuals into typologies according to utilization of each stage in the mental health and substance cascades of care. Then, we examined county and agency characteristics that affect three stages of the cascade process: identification of need for behavioral health services, referrals to appropriate services, and treatment initiation. We build on previous work by exploring these patterns for both SUD and MHD treatment.
The study identified four SUD/MHD treatment patterns: Low Access, SUD-Focused, High Need-High Access, and Lower Need-High Access classes. Factors influencing typology alignment include location, specialized staff availability, warm hand-off coordination, Medicaid reimbursement, and performance measure tracking. Thirty-nine percent (39 %) of agencies could not be classified because they were unable to report their rate of care along the cascade measures.
Focusing on factors influencing typology assignment can help counties in assessing service delivery, identifying barriers, and targeting areas for improvements in policies and practices, potentially facilitating long-term changes and overall improvement in the care of individuals with mental health and substance use disorders. Identification of these factors and typologies can improve mental health treatment and access in counties and agencies with large resource barriers or limited attention to mental health treatment.
与普通人群相比，涉及司法程序的人群的物质使用障碍（SUD）和精神健康障碍（MHD）发生率要高得多。尽管 SUD 和 MHD 的发生率很高，但针对该人群的治疗通常受到限制，并且缺乏循证依据。护理级联模型估计，从筛查到确定需求、转介、护理启动、护理参与和护理完成，护理连续体的各个环节都存在流失。最近，医疗保健提供者利用护理级联模型来改善司法环境中 SUD 和 MHD 患者的护理连续性。本研究的目的是：1）确定解释 SUD 和 MHD 新入组者通过护理级联各个阶段的比例的类型学；2）描述机构层面的因素，这些因素可预测类型学分配和机构评估客户在护理级联各个水平流动的能力。
我们使用潜在类别分析，根据在精神健康和物质护理级联中利用每个阶段的情况，将为涉及司法程序的个人提供服务的 791 家机构分为不同类型。然后，我们研究了影响行为健康服务需求识别、适当服务转介和治疗启动这三个级联过程阶段的县和机构特征。我们通过探索 SUD 和 MHD 治疗的这些模式，进一步拓展了之前的工作。
该研究确定了四种 SUD/MHD 治疗模式：低访问、SUD 重点、高需求-高访问和低需求-高访问。影响类型学一致性的因素包括位置、专业人员可用性、温情交接协调、医疗补助报销和绩效衡量跟踪。39%的机构无法进行分类，因为它们无法报告沿着级联措施的护理率。
关注影响类型学分配的因素可以帮助各县评估服务提供情况，识别障碍，并针对政策和实践中的改进领域，潜在地促进个人的长期变化和整体改善，他们患有精神健康和物质使用障碍。确定这些因素和类型学可以改善有大量资源障碍或对精神健康治疗关注有限的县和机构的精神健康治疗和可及性。
