Enhancing the Evidence for Specialty Mental Health Probation: A Hybrid Efficacy-Implementation Controlled Trial

Probationers with mental illness are disproportionately represented in the criminal justice system compared to probationers without mental illness. There is evidence indicating that risk factors associated with criminal justice involvement are the same for offenders with and without mental illnesses. However, it is not clear whether these criminogenic risks predict different types of probation violations. State and local agencies have implemented specialty mental health probation (SMHP) to address violations and rearrests among this population. Although evidence for SMHP is building, there are two main limitations: lack of knowledge about the implementation challenges and facilitators of SMHP and lack of rigorous evidence of the efficacy of SMHP. Paper one examines statewide administrative data to compare criminogenic risk factors among probationers without mental illness, probationers with mental illness and probationers with severe mental illness. Results suggest that mental illness impacts the number and type of probation violations; however, additional variables such as those related to officer-, organizational-, and system-level factors should be examined to understand the role of mental illness in probation violations. Papers two and three describe the methods and results for a hybrid implementation-efficacy controlled trial of SMHP. Paper two reports on the implementation arm of the study and analyzes semi-structured interviews from 26 stakeholders, including mental health, criminal justice, and research team stakeholders, to examine the challenges and facilitators of implementing SMHP. Challenges and facilitators to implementing SMHP were associated with the inner setting, outer setting, and implementation process. Paper three reports results from a randomized control trial of SMHP in which 106 probationers with mental illness were randomly assigned to standard probation or specialty mental health probation. Results indicate core differences between SMHP officers and standard probation officers in terms of their focus on probationers’ mental health service connection. In addition, results suggests that SMHP officer efforts may also result in higher rates of accessing mental health services. This research makes a significant contribution to the literature by addressing risk factors for probation violations among probationers with mental illness, the rigor of evidence supporting SMHP, and the real world challenges probation and mental health agencies experience when implementing SMHP.Doctor of Philosoph