Objective

Although drug treatment courts (DTCs) have demonstrated positive outcomes, participants with co-occurring mental health and substance use disorders (CODs) are a high-risk group that often struggle with treatment engagement not previously examined. This pilot study fills this gap by looking at six-month behavioral health and criminal justice outcomes among a hard to engage DTC COD participant sample in two Massachusetts DTCs receiving a wraparound-treatment (Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice - MISSION-CJ).

Methods

Participants were evaluated at baseline and at six-month follow-up. Bivariate analyses examined baseline differences between clients with higher versus low engagement were examined. A mixed analysis of variance (ANOVA) for repeated measures with time as the within subject factor, and level of engagement as the between subject factor was performed for criminal justice (CJ) and behavioral health outcomes.

Results

Participants were primarily male (86.6%), White (90.6%), living in unstable housing (86.2%), had an average of 18.94 years of criminal justice involvement, had an average of 15.49 years of regular illicit substance use, and mild mental health symptoms as measured by the BASIS-32 average total score (0.51), with no statistically significant differences at baseline from bivariate analyses. Mixed ANOVA results demonstrated significant effect time of time in MISSION-CJ on reducing nights in jail (p = 0.0266), opioid use (p = 0.0013), and mental health symptom (p = 0.0349). Additional improvements in nights in jail p = 0.0139), illicit substance use (p = 0.0358), and opioid use (p = 0.0013), were observed for clients that had high engagement in MISSION-CJ.

Conclusions

Wraparound services, such as MISSION-CJ, alongside DTC programming for a chronic relapsing DTC population can improve engagement in treatment and CJ and behavioral health outcomes. Future research is needed with MISSION-CJ that includes a randomized trial and a larger sample.

中文翻译：

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在药物治疗法庭上让弱势群体参与：同时发生的障碍环绕干预的六个月结果

客观的

尽管药物治疗法庭 (DTC) 已经显示出积极的结果，但同时发生精神健康和物质使用障碍 (COD) 的参与者是一个高风险群体，他们经常在以前未曾检查过的治疗参与中挣扎。这项试点研究填补了这一空白，在接受环绕治疗（通过系统集成、外展和网络保持独立性和清醒性）的两个马萨诸塞州 DTC 中，一个难以参与的 DTC COD 参与者样本在六个月的行为健康和刑事司法结果中填补了这一空白。刑事司法 - MISSION-CJ）。

方法

在基线和六个月的随访中对参与者进行了评估。双变量分析检查了参与度较高与低度的客户之间的基线差异。针对刑事司法 (CJ) 和行为健康结果，对重复测量进行了混合方差分析 (ANOVA)，以时间为主体内因素，参与度为主体间因素。

结果

参与者主要是男性 (86.6%)、白人 (90.6%)、居住在不稳定的住房 (86.2%)、平均有 18.94 年的刑事司法介入、平均有 15.49 年的经常使用非法药物和轻度精神障碍通过 BASIS-32 平均总分 (0.51) 衡量的健康症状，与双变量分析相比，基线在统计学上没有显着差异。混合方差分析结果表明，MISSION-CJ 中的时间对减少监狱夜数 ( p  = 0.0266)、阿片类药物使用 ( p  = 0.0013) 和心理健康症状 ( p  = 0.0349) 有显着影响。监狱夜数的额外改善p  = 0.0139)、非法药物使用 ( p  = 0.0358) 和阿片类药物使用 ( p = 0.0013)，观察到在 MISSION-CJ 中高度参与的客户。

结论

环绕式服务，例如 MISSION-CJ，以及针对慢性复发性 DTC 人群的 DTC 编程，可以提高治疗参与度以及 CJ 和行为健康结果。未来的 MISSION-CJ 研究需要包括随机试验和更大的样本。