Bipolar Disorder, Criminal Behavior, Schizophrenia
Conditions
Brief summary
This study evaluates the Rochester Forensic Assertive Community Treatment (R-FACT) model in Minnesota. R-FACT is an enhanced version of Assertive Community Treatment designed to support individuals with serious mental illness who are involved in the criminal justice system. Participants were randomly assigned to receive either the R-FACT intervention or standard outpatient mental health services. The study examines whether R-FACT reduces criminal justice involvement, improves mental health outcomes, and enhances community functioning compared to usual care over a 24-month follow-up period.
Detailed description
The R-FACT intervention includes a multidisciplinary team approach with reduced caseloads, enhanced supervision, and collaboration with criminal justice stakeholders. This randomized controlled trial evaluates the effectiveness of the Rochester Forensic Assertive Community Treatment (R-FACT) model in Minnesota. R-FACT is a modified Assertive Community Treatment (ACT) model developed to address the needs of individuals with serious mental illness who are at high risk for criminal justice involvement. The model integrates best practices in community mental health (high-fidelity ACT) with best practices in community correctional supervision (Probation officers trained in Effective Practices in Community Supervision - EPICS) The study was conducted across two counties in Minnesota and enrolled adults with serious mental illness who were on probation or undergoing correctional facility release to probation. Participants were randomized to either the R-FACT intervention or standard outpatient mental health treatment. The R-FACT intervention consists of a high-fidelity ACT team that collaborates closely with specially assigned probation officers who provide community correctional oversight of all R-FACT service recipients. The comparator group received usual care through existing outpatient mental health services along with standard probation.
Interventions
BEHAVIORALR-FACT intervention
A structured, team-based model of care adapted from Assertive Community Treatment (ACT) that provides intensive, community-based psychiatric services with integrated supervision and coordination with criminal justice and social service systems. The model emphasizes reduced caseloads, frequent participant contact, continuity of care, and collaborative problem solving between mental health and criminal justice staff with an emphasis on finding therapeutic alternatives to punishment.
BEHAVIORALStandard Outpatient Treatment
Routine outpatient mental health services delivered through existing community systems, including standard psychiatric care and case management without the enhanced structure or intensity of the R-FACT model.
Sponsors
University of Rochester
Arnold Ventures
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
This study was open-label. Participants and care providers were aware of treatment assignment due to the nature of the intervention. Outcome data were obtained from administrative databases, reducing the risk of assessment bias.
Intervention model description
Participants were randomized to one of two groups: the Rochester Forensic Assertive Community Treatment (R-FACT) intervention or standard outpatient mental health treatment. Outcomes were compared between groups over a 24-month follow-up period.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 or older. * DSM-5 diagnosis of a psychotic disorder, including schizophrenia, schizoaffective disorder, bipolar disorder, or major depression with psychotic features. * Adequate command of English to understand study instructions. * Capacity to provide informed consent. * Under community correctional supervision or undergoing prison release planning at the time of enrollment.
Exclusion criteria
* Age under 18. * Lack of a psychotic disorder diagnosis. * Inability to speak English. * Lack of capacity to provide informed consent. * Absence of community correctional supervision or of release planning. * Presence of legal oversight in the community from a source other than probation or community corrections. Examples include having legal oversight from a mental health court, a drug court, or from an assisted outpatient treatment (AOT) program.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Total Number of Days Incarcerated During the 24 Month Follow Up Period | Randomization to 24 months after randomization | Incarceration days are measured using administrative correctional records. For each participant, the total number of days incarcerated during the 24 month follow up period is calculated from correctional database records. The outcome is reported as the mean total number of incarceration days per participant within each study arm. Higher values indicate more time spent incarcerated, and lower values indicate less time spent incarcerated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Total Number of Arrests During the 24 Month Follow Up Period | Randomization to 24 months after randomization | Arrests are measured using administrative criminal justice records. For each participant, all arrests occurring during the 24 month follow up period are counted. The outcome is reported as the mean total number of arrests per participant within each study arm. Higher values indicate more arrests. |
| Mean Total Number of Convictions During the 24 Month Follow Up Period | Randomization to 24 months after randomization | Convictions are measured using administrative criminal justice records. For each participant, all convictions occurring during the 24 month follow up period are counted. The outcome is reported as the mean total number of convictions per participant within each study arm. Higher values indicate more convictions. |
| Mean Total Number of Community Supervision Violations During the 24 Month Follow Up Period | Randomization to 24 months after randomization | Community supervision violations are measured using administrative criminal justice records. For each participant, all probation or parole violations occurring during the 24 month follow up period are counted. The outcome is reported as the mean total number of violations per participant within each study arm. Higher values indicate more violations. |
| Mean Total Number of Jail Stays During the 24 Month Follow Up Period | Randomization to 24 months after randomization | Jail stays are measured using correctional administrative records. For each participant, the number of separate jail admissions occurring during the 24 month follow up period is counted. The outcome is reported as the mean total number of jail stays per participant within each study arm. Higher values indicate more jail admissions. |
Countries
United States
Outcome results
None listed