Absence of conflict of interest.
Godley, S. H., Finch, M., Dougan, L., McDonnell, M., McDermeit, M., & Carey, A. (2000). Case management for dually diagnosed individuals involved in the criminal justice system. Journal of Substance Abuse Treatment, 18(2), 137–148.
- The study’s objective was to examine the relationship between the Treatment Alternatives for Safe Communities/Mental Illness Substance Abuse (TASC/MISA) program and a range of outcomes, including education and training, employment, public benefit receipt, and recidivism outcomes.
- The authors used a nonexperimental interrupted time series (ITS) study design to compare the outcomes of people with prior justice-system contact and mental health and substance abuse issues, before and after participating in the TASC/MISA program. Using survey data, the authors looked at the change in participants’ Addiction Severity Index (ASI) scores, incarceration, and other outcomes between baseline and six months following program intake.
- The study found that program participation was associated with less favorable employment and education outcomes but favorable recidivism outcomes. Associations between participation and public benefit receipt outcomes were mixed.
- The quality of causal evidence presented in this report is low. This means we are not confident that the estimated effects on education and training, employment, public benefit receipt, and recidivism outcomes are attributable to the program; other factors are likely to have contributed.
The Treatment Alternatives for Safe Communities/Mental Illness Substance Abuse (TASC/MISA) program
Features of the Intervention
The TASC/MISA program was a three-year demonstration project funded by the Office of Rural Health Policy of the Health Resources and Services Administration, which aimed to serve justice-involved people with severe mental health and substance abuse issues by providing intensive case management services. Multiple case managers typically assisted clients with referrals and linkages to other services; monitored progress and assisted clients in other areas of need such as employment, health, and financial literacy; provided feedback to other service providers; reinforced treatment goals; made home visits; and involved significant others in services.
To be eligible for TASC/MISA, clients had to have a major psychiatric diagnosis and a substance abuse/dependence diagnosis, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and involvement with the criminal justice system, but not a significant history of violent acts. The client also could not be receiving intensive case-management services from another service provider. Case managers provided services mostly at community-based sites, but also at locations more convenient to participants, such as clients’ residences, public places, social service agencies or substance abuse treatment agencies, health-related agencies, schools, and at clients’ workplaces.
Features of the Study
The authors used a nonexperimental ITS study design to compare the education and training, employment, public benefit receipt, and recidivism outcomes of people with prior justice-system contact who had mental health and substance abuse issues before and after participating in the TASC/MISA program. They analyzed the change in participants’ ASI scores as well as information on incarceration and other factors, which were collected at baseline and six months following program intake.
Education and training
- The authors found that the percentage of participants attending school decreased significantly at six months following enrollment.
- The authors found that paid employment among TASC/MISA program participants decreased by 20 percentage points at six months following enrollment, which was statistically significant.
Public benefit receipt
- The authors found that participants’ receipt of Supplemental Security Income benefits decreased by 11 percentage points, and their receipt of Social Security Disability Insurance benefits increased by 13 percentage points at six months following program enrollment. These differences were statistically significant. The authors found no statistically significant relationship between participation in the TASC/MISA program and receipt of other public benefits.
- The authors found that the percentage of participants jailed in the past six months decreased by 48 percentage points, and the number of days participants were jailed in the past six months decreased by 31.7 days, on average. These relationships were statistically significant. However, the authors found no significant relationship between program participation and the number of times participants were jailed during the six months following program enrollment.
Considerations for Interpreting the Findings
The authors compared the outcomes of TASC/MISA program participants measured before and after they participated in the intervention. For these types of designs, the authors must observe outcomes for multiple periods before the intervention to rule out the possibility that participants experienced increasing or decreasing trends in the outcomes of interest before enrolling in the program. That is, if participants who had decreasing involvement in the justice system tended to enroll in the program, we would anticipate further decreases over time, even if they did not participate in the program. Without knowing the trends before program enrollment, we cannot rule this out. Therefore, the study receives a low causal evidence rating.
The study authors estimated multiple impacts on outcomes related to employment, public benefit receipt, and recidivism. Performing multiple statistical tests on related outcomes increases the likelihood that some impacts will be found statistically significant purely by chance and not because they reflect program effectiveness. The authors did not perform statistical adjustments to account for the multiple tests, so the number of statistically significant findings in these domains is likely to be overstated.
Finally, the study was based on a small sample of 54 people, which could reduce the precision and generalizability of the findings. Moreover, the study obtained follow-up data for only 76 percent of the participants, which could lead to nonresponse bias if those who provided data differed systematically from those who did not in ways related to the outcomes.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors did not account for trends in outcomes before the intervention. This means we are not confident that the estimated effects are attributable to the TASC/MISA program; other factors are likely to have contributed.