Program Profile: Specialty Mental Health Probation (Texas)

The program targeted individuals on probation with a mental illness. The goal was to reduce rates of community supervision failures. The program is rated Promising. Individuals on specialty probation had both statistically significant lower rates of technical violations and rearrest, and higher receipt of mental health services and dual-diagnosis treatment, compared with individuals on traditional probation. There was no statistically significant impact on substance use treatment and violence.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals/Target Population

Specialty mental health probation was a community-based program for individuals with an Axis I mental illness who were sentenced to probation. The objective was to improve the process and outcomes of probation for those with mental illness by connecting them with psychiatric treatment and avoiding probation violations. The goal of the program was to reduce disproportionately high rates of community supervision failures among individuals on probation with mental illness.

Program Components

Specialty officers were assigned relatively small caseloads (fewer than 50) consisting solely of individuals on active probation who also had a mental health diagnosis. Specialty officers were trained on issues relevant to mental illness, spent considerable time discussing mental health issues with individuals on probation, actively coordinated and integrated internal and external resources for individuals on probation, and worked closely with treatment providers.

The organizational structure of the program, such as small caseloads and ongoing officer training, provided specialty officers with the time and skills necessary to connect individuals with a mental health need to resources such as psychiatric treatment, and provided a foundation for specialty officers to supervise individuals in a manner that balances rehabilitation and supervision. These officers attempted to make threats, sanctions, and jail time last resorts, and instead used collaborative problem-solving techniques to obtain compliance from individuals on probation. Individuals on mental health specialty probation received, in addition to specialized care and positive compliance strategies, services such as mental health treatment (including psychiatric services), substance use treatment, and dual diagnosis treatment

Study

Manchak and colleagues (2014) conducted a longitudinal matched design study in which individuals on traditional probation were compared with individuals on specialty probation to determine whether individuals on specialty probation would achieve greater access to services and decreased violations. A prototypical specialty agency and traditional agency (i.e., probation as usual) were chosen for the study. Both sites were chosen from a national survey of specialty (n = 66) and traditional (n = 25) agencies (Skeem, Emke–Francis, and Eno Louden, 2006). The specialty and traditional agencies chosen were similar regarding jurisdiction size, urban location, demographic characteristics of the probation population served, and county mental health expenditures. To be eligible for participation, individuals on active probation had to have at least 1 year remaining on their probation term, have met with their supervising officer at least once since starting probation, and to be ages 18 to 65. Additionally, participants had to be English speaking, able to provide informed consent, identified as having an Axis I mental illness, and without comorbid intellectual disability.

Participants in the treatment group (n = 183) were chosen from a prototypical specialty agency and were therefore under the supervision of specialty officers (as described under the Program Description). Participants in the control group (n = 176) were chosen from a traditional probation agency and were therefore under the supervision of traditional probation officers. Traditional probation officers tend to supervise large caseloads (the average was more than 100 cases), in comparison with specialty officers. Traditional officers typically broker services and often are not involved in treatment decisions; rather, they refer those on probation to community providers and resources. Participants on traditional probation also received services such as mental health treatment, substance use treatment, and dual-diagnosis treatment.

To account for differences between the treatment and control groups, participants from the specialty probation agency and traditional probation agency were matched on gender, age, ethnicity, length of time on probation, and index offense. On average, the full study sample was 37 years old, mostly Black (about 50 percent) or white (about 38 percent), and the majority were male (57 percent). In both the treatment and control groups, about 12 percent of participants identified as Hispanic. A total of 102 probation officers (specialty n = 15; traditional n = 87) supervised the 359 individuals on probation at baseline. Officers at the specialty probation site were on average 42 years old and had worked an average of 9 years as a probation officer; 20 percent were male, 7 percent were Hispanic, 53 percent were white, and 33 percent had higher than a bachelor’s degree. Officers at the traditional probation site were on average 46 years old and had worked an average of 15 years as a probation officer; 48 percent were male, 14 percent were Hispanic, 10 percent were white, and 11 percent had higher than a bachelor’s degree.

The outcomes of interest were technical violations, receipt of mental health treatment, substance abuse treatment, and integrated dual-diagnosis treatment. Data on receipt of services were obtained from self-report data and public and county billing databases. Data on technical violations were obtained from each study participant’s electronic and hardcopy probation record, and from court appearance transcriptions and summaries. A series of binary logistic regressions were conducted in which a) the criterion variable was either treatment involvement (yes/no for one of three types of treatment: mental health, substance use, or dual diagnosis) or receipt of a formal violation report (yes/no); b) the predictor was probation site (specialty/ traditional); and c) propensity scores were covariates. Propensity score matching was used to control for treatment assignment and person on probation effects. Additionally, officer nesting effect was controlled for using a specific command in Stata. The study did not conduct subgroup analyses.

Study

Skeem, Manchak, and Montoya (2017) conducted a longitudinal quasi-experimental design study to assess the impact of specialty probation on a variety of outcomes. The results of a national survey on probation and mental health were used to select two urban agencies that exemplified the specialty model (in Texas) or the traditional model (in California). The sites were similar in jurisdiction size, characteristics of those on probation, and mental health expenditures. Enrollment for participation in the study began Oct. 19, 2005; follow-up data were completed Jan. 26, 2013. To be eligible for participation, participants had to be ages 18 to 65, English speaking, on active probation, identified as mentally ill, and able to provide voluntary and informed consent.

The sample consisted of 359 individuals on probation with serious mental health problems and functional impairment. Participants in the treatment group and control group were matched on age, sex, race/ethnicity, probation time, and offense. Individuals in the treatment group who received specialty probation (n = 183) were on average 36 years old; 54 percent were male, and 37 percent were white (nonwhite comparison). The average Colorado Symptom Index score was 30, which is the cutoff score for psychiatric disability, and the average researcher-rated psychiatric functioning score (Global Assessment of Functioning score) was 45. Individuals in the control group who received traditional probation (n = 176) were on average 37 years old; 60 percent were male, and 38 percent were white. The average Colorado Symptom Index score was 25, and the average researcher-rated psychiatric functioning score was 54.

The two outcomes of interest were violence and rearrest. Official probation records and self-report data from probation officers and individuals on probation were used to assess involvement in aggressive acts. Violence was defined as physical battery, sexual assault, threat with a weapon in hand, or an assaultive act with a weapon that occurred within 1 year. The Federal Bureau of Investigation reports regarding the person on probation were obtained to assess rearrest during a period of 2 to 5 years. Arrests solely for probation violations were excluded. Targeted maximum likelihood estimation (TMLE) was used to estimate the association between specialty probation and violence (1 year) and rearrest (2 years). The study did not conduct subgroup analyses.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Eno Louden, Jennifer, Perman Gochyyev, and Jennifer L. Skeem. 2020. “Do Specialty Programs for Justice-Involved People With Mental Illness Exacerbate Stigma?” Criminal Justice and Behavior 47(10):1211–27.

Rabe–Hesketh, Sophia, and Anders Skrondal. 2008. Multilevel and Longitudinal Modelling Using Stata. College Station, Texas: Stata Press.

Skeem, Jennifer L., Paula Emke–Francis, and Jennifer Eno Louden. 2006. “Probation, Mental Health, and Mandated Treatment: A National Survey.” Criminal Justice and Behavior (33):158–84.