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OBJECTIVE: Moral Reconation Therapy (MRT) is a cognitive-behavioral intervention to reduce risk for criminal recidivism. Despite being implemented widely in correctional settings, there are no randomized controlled trials of MRT, and its effectiveness for reducing recidivism among justice-involved adults in non-correctional settings is unknown. METHODS: In a pragmatic trial, 341 justice-involved patients (95.3% male; 57.8% White/Non-Hispanic) admitted to one of three mental health residential treatment programs were randomly assigned to usual care (UC) or UC plus two MRT groups per week for 12 weeks. Follow-ups were conducted at 6- and 12-months post-baseline (71.3% and 74.8% retention, respectively). Primary outcomes were criminal thinking and criminal associates. Secondary outcomes were legal problem severity, days incarcerated in the past 30, rearrested/charged (per official records), substance use, and employment and family/social problems. The study design, analysis, and outcomes were preregistered (ClinicalTrials.gov; ID:NCT02524171). RESULTS: Patients in both conditions improved over time on most outcomes. In intent-to-treat analyses, the rate of change in outcomes over time did not differ by condition, nor did the prevalence of being rearrested and charged within one year of baseline (UC=20.2%, MRT=24.9%; OR=1.14; 95% CI[0.67,1.94], p=.63). MRT engagement was low; 37% of those randomized to MRT received a minimum dose–i.e., completed at least Step 3. In per-protocol analyses, this subgroup, relative to UC, improved more on criminal associates, days incarcerated, legal problem severity, and alcohol use severity. CONCLUSIONS: In this study, MRT was not more effective than usual care at reducing recidivism risk for patients in mental health residential treatment.

Police officers initiate psychiatric holds following determination of suicide risk. Such referrals constitute direct decriminalization of mental illness at the single most efficient criminal justice system diversion point. However, system-level problems with this process highlight a need to further understand and improve this service connection juncture. The goal of the present study was to inform the development of a smartphone application designed to enhance police referrals of individuals experiencing suicide crises into treatment via culturally responsive structured professional judgment.Given the developmental and qualitative nature of this study, there were no formal hypotheses tested. Research questions included the following: Would police officers broadly endorse concerns about the care referral process? Would officers support the use of technology to assist with those concerns? And would officers raise concerns about the demands on time and expertise that would be placed on them to conduct thorough risk assessments?Researchers used community-based participatory research (CBPR) methods to obtain police stakeholder-driven data through four focus groups with 47 police officers (76.6% male, 59.6% White, with a mean of 10.7 years of police employment) sampled from patrol and hostage negotiation units. Participants shared information about specific problems arising in the process through which police refer people to medical care, and they gave feedback on the beta version of a culturally responsive mobile app designed to streamline officers' evidence-based and culturally informed determinations of suicide risk.Results, qualitatively coded using grounded theory methodology, yielded key considerations for police use of culturally responsive apps to divert individuals in suicidal crisis into treatment, including the need to maintain a balance between risk assessment and communication, allow for variance in time constraints, allow for flexibility in response and report options, account for inaccurate reports of suicide risk factors, maximize utility of the app's risk report output, incorporate sensitivity around cultural questions, and consider officers' safety in their use of the app in the field.The results illustrate a theoretically based (CBPR) approach to cross-disciplinary technology development to facilitate evidence-based assessments by law enforcement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).