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Little research has focused on systematically integrating clinical treatment within drug court settings (a type of specialty court, and the most popular type of alternative to incarceration program). This is particularly important for rural drug courts serving participants with both co-occurring mental health and substance use disorders, as these participants often have difficulty engaging in care which is compounded by limited access to treatment services in their communities. This article reports on the preliminary outcomes and policy implications of integrating MISSION-Criminal Justice (MISSION-CJ), a co-occurring mental health and substance use hybrid wraparound treatment and linkage intervention, within a rural Massachusetts drug court. In this open pilot, 73 participants completed an intake and 80% completed a 6-month follow-up assessment. The participants were primarily Caucasian (83.6%), male (57.5%), reported substantial criminal justice histories with an average of 13.93 prior arrests, had extensive substance use and mental health histories, with 71% reporting opioid use, 74% had anxiety, and 68.5% depression at intake. Six-month data indicate statistically significant reductions in nights spent in jail, number of arrests, acute behavioral health symptoms, illicit drug use, as well as an increase in employment and securing stable housing. These data suggest that MISSION-CJ was feasible to implement within a rural drug court. MISSION-CJ is a unique intervention as it offers co-occurring disorders treatment and linkage services that work both within a specialty court setting and in the community. These findings pose critical policy implications as integrated services and a hybrid treatment model are considered to be best practice and may be optimal for rural drug courts where there are limited treatment and service resources. [ABSTRACT FROM AUTHOR]

Objective: Despite the growing research on the effectiveness of specialty courts, including drug treatment courts (DTCs) and veterans treatment courts (VTCs), little is known about the unique treatment needs of individuals with co-occurring mental health and substance use disorders (COD) who are commonly served by these courts. This pilot study examines individuals with COD across two DTCs and two VTCs in Massachusetts to understand the characteristics and treatment needs of these unique populations. Methods: Baseline data for 112 individuals enrolled in a community-based COD treatment program within two DTCs (N = 86) and two VTCs (N = 26) with a Monte Carlo simulation of 10,000 samples were analyzed to assess differences in treatment needs. Results: DTC participants experienced more lifetime convictions (p =.000), months incarcerated (p =.000), and had a longer lifetime history of illicit drug use (p =.004). Meanwhile, a higher proportion of VTC participants experienced trauma (p <.002) and chronic medical problems (p <.001), and VTC participants experienced more severe acute behavioral health symptoms as measured by the BASIS-32 (p =.021). Conclusions: Given the unique differences in treatment needs between DTC and VTC participants, these findings have implications for specialty court management such as treatment planning, referrals to meet participants' service needs, and even docket sizes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Mental health courts provide an alternative to incarceration and address both mental health and criminal justice needs. Many individuals within these treatment courts also have co-occurring substance use disorders. This pilot study examined the preliminary effectiveness of Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice (MISSION-CJ), an intervention that targets co-occurring disorders and criminal justice risk factors within a mental health court., Methods: Participants (N=97) were enrolled in mental health court and MISSION-CJ community wraparound services., Results: Participants were primarily male with an average age of 34, had spent an average of more than 5 years incarcerated, and had an average of 13.94 years of illegal drug use; 91% had experienced depression. Preliminary 6-month outcomes showed significant reduction in nights incarcerated (p<0.002), illegal drug use (p<0.003), trauma symptoms (p<0.004), and behavioral health symptoms (p<0.006)., Conclusions: Preliminary findings suggest promise for delivery of MISSION-CJ to participants in a mental health court.