RecruitingNot ApplicableNCT06564948

Treatment for Individuals Interacting with the Criminal Justice System

Improving Mental Health Treatment for Individuals in Crisis Interacting with the Criminal Justice System

Sponsor

Cambridge Health Alliance

Enrollment

1,040 participants

Start Date

Feb 1, 2025

Study Type

INTERVENTIONAL

Conditions

Suicide Risk Psychiatric Disorders

Summary

The proposed Center will leverage burgeoning real-time data linkage capabilities among health systems, Medicaid payors, and criminal legal (e.g., jail booking data, jail release data) systems, to identify individuals coming in and out of jail for suicide assessment and prevention, and to better coordinate care across these disparate systems. This Center will advance the fields of suicide prevention and criminal legal system-based mental health by solving a well-known, central problem in both fields: the inability to track and intervene with individuals moving in and out of both and often multiple systems. The goal is near-term reductions in the U.S. suicide rate.

Eligibility

Min Age: 18 YearsMax Age: 100 Years

Inclusion Criteria14

Treatment as Usual (TAU) arm
Cambridge Health Alliance (CHA) patients from the cities other than Cambridge considered to be in the "catchment area" of CHA (Everett, Chelsea, Somerville, Medford, Malden, and Winthrop)
Ages 18-100
Identified as having police involvement between 2009 and 2019. Treatment as Usual patients will be identified using "targeted limited chart review methods" used in our prior studies, "scraping" clinical notes in the Electronic Health Records for criminal justice involvement. Initial Identification terms, "police", "arrest", "court", "summons", "jail", and "crime" will be used to identify candidates for police involvement, downloading the sentence in which the keyword appeared and the sentence before and after. Next, an iterative process of editing of the search terms will be conducted to remove patients with negation of the keyword ("did not commit a crime"), and other sentence characteristics that generate false positives ("cardiac arrest"). Samples of the resulting dataset will be taken, accuracy assessed by examining the surrounding sentences, leading to further iterations and repetition of the process until a high level of accuracy is achieved.
Family and Social Justice Section (FSJS) arm
Cambridge Health Alliance patients from Cambridge
Ages 18-100
Individuals who have come into contact with the Cambridge Police Department (as identified in the Family and Social Justice Section data) between 2009 and 2019.
Family and Social Justice Section plus Navigator (FSJS+Navigator) arm
Recruited during the study period in the CHA ED
Ages 18-100
Individuals who are brought into the Emergency Department under police supervision (excluding individuals currently incarcerated)
involuntarily brought to the Emergency Department for psychiatric evaluation because they are considered to be a risk to themselves or others (MA Law 123(12)); or
the subject of a police call for service for a mental health issue who are willingly admitted to the Emergency Department

Exclusion Criteria15

Treatment as Usual (TAU) arm
Cambridge Health Alliance patients residing in the City Cambridge are excluded from the TAU arm
Under the age of 18
Individuals with no identified criminal legal system contact during the study time period (no criminal legal involvement found in the targeted limited chart review method).
Any individual incarcerated at the Middlesex Jail/Prison that has not been released by the end of the period of data collection (December 31, 2019).
Family and Social Justice Section (FSJS) arm
Cambridge Health Alliance patients outside of Cambridge will be excluded from the FSJS arm
Under the age of 18
Any individual incarcerated at the Middlesex Jail/Prison that has not been released by the end of the period of data collection (December 31, 2019)
Family and Social Justice Section plus Navigator (FSJS+Navigator) arm
Under the age of 18
Any individual who becomes incarcerated during the course of the study
Individuals who enter the Emergency Department not under police supervision
For example, individuals will be excluded who voluntarily come to the ED seeking psychiatric care because they feel they may be a risk to themselves or others
Individuals brought to the ED from a jail or court ordered to the ED as an alternative to jail or prison

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Interventions

OTHERTreatment as usual (TAU)

TAU patients will be identified using "targeted limited chart review methods" used in our prior studies, "scraping" clinical notes in the EHR for criminal justice involvement. Initial Identification terms, "police", "arrest", "court", "summons", "jail", and "crime" will be used to identify candidates for police involvement, downloading the sentence in which the keyword appeared and the sentence before and after. Next, an iterative process of editing of the search terms will be conducted to remove patients with negation of the keyword ("did not commit a crime"), and other sentence characteristics that generate false positives ("cardiac arrest"). Samples of the resulting dataset will be taken, accuracy assessed by examining the surrounding sentences, leading to further iterations and repetition of the process until a high level of accuracy is achieved.

OTHERFamily and Social Justice

Documentation and follow-up by the Cambridge Police Department (CPD) for all mental health-related police calls, including involuntary and voluntary Emergency Department admissions; Established partnerships with city departments, healthcare systems, clergy, courts, businesses, and mental health advocates to ensure timely engagement in mental health treatment and community-based services; Required 40 hours of officer crisis intervention training (CIT), and additional sessions on trauma- informed policing, mental health, procedural justice, race, and crisis negotiation; and Staffing of sworn and civilian staff including specially-trained officers designated to work with individuals living with mental illness, homelessness, and substance abuse.

OTHERFamily and Social Justice Service and Navigator (FSJS+Navigator) Intervention

The FSJS+Navigator intervention adds an Emergency Department (ED)-based Systems Navigator, a community health worker with lived experience (as family member or patient) with criminal justice and mental health systems, to the FSJS. This navigator will enhance communication between Cambridge Police Department (CPD), Cambridge Health Alliance (CHA), and community agencies by being the needed "point person" within the healthcare system (the FSJS intervention only has a CPD-based social worker) to maintain communication to improve mental health services and prevent deeper justice involvement. The Navigator engages with the FSJS process in step i) of the above sequence, engaging the patient in the CHA ED and obtaining consent. The Navigator then discusses the case with the presenting CPD officer, and relays critical information about the context of the service call to ED staff. Next, the Navigator will administer the baseline CAT-MH/SS and assess additional needs (employment, housing, food).