Graduation Year

2024

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Mental Health Law and Policy

Major Professor

Kathleen Moore, Ph.D.

Committee Member

Holly Hills, Ph.D.

Committee Member

Paul Stiles, JD, Ph.D.

Committee Member

Natalie Bonfine, Ph.D.

Keywords

behavioral health, criminal justice, factor analysis, implementation science, sequential intercept model

Abstract

Adults with behavioral health issues (BHIs) are disproportionately represented in the criminal justice system (CJS). Local-level system fragmentation perpetuates this disparity. The following studies advance an understanding of the Sequential Intercept Mapping Workshop (SIM-W). The SIM-W is a local-level strategic planning workshop used to address gaps in services, improve local-level partnerships, and co-develop a strategic plan with marginalized groups, county leaders, and cross-system service providers to guide the implementation and delivery of evidence-based jail diversion strategies. Over 300 SIM-Ws have been conducted across the United States, incentivized through state/federal legislation. However, the SIM-W process components and outcomes remain under-explored. Specific knowledge-gaps include (1) the types of service gaps that are prioritized and what strategies are used to address these gaps, (2) the types of stakeholders who attend SIM-Ws and engage in implementation efforts, and (3) factors that affect strategic plan development and implementation.

Three exploratory analytic approaches were used to fill these knowledge-gaps and provide a sequential, data-driven analysis. SIM-Ws completed by state-level technical assistance centers in Florida and Ohio were selected to explore SIM-Ws across diverse settings and provided a convenient sample to analyze SIM-W strategic plan and recruit study participants. Study 1: A directed content analysis was used to investigate SIM-W strategic plans (N=48). Focal variables included priority service gaps, strategies to address service gaps, and the types of stakeholders involved in strategic plan development and implementation. Most prioritized service gaps were related to community-based support, crisis response services, and cross-system collaboration. Strategies to address prioritized service gaps were mostly exploratory and ambiguous. The largest proportion of stakeholders who attended the SIM-W and were responsible for implementing the strategic plan were affiliated with the behavioral health system. Study 2: A grounded theory approach involving semi-structured interviews with 19 SIM-W attendees explored perceptions of strategic plan development and implementation. The Strategic Implementation Ecosystem emerged as the core construct. Key factors associated with effective plan development included (1) pre-existing networks, (2) planning champions, (3) engagement, and (4) facilitation. Key factors associated with implementation outcomes included (1) situational constraints, (2) strategic plan quality, (3) follow-up support, (4) implementation champions, (5) collaboration, and (6) ownership. Study 3: Surveys were disseminated to SIM-W attendees (N=68) to empirically investigate factors identified within the Strategic Implementation Ecosystem. Exploratory factor analyses were used to extrapolate latent constructs, which were input into two multiple regression models to examine the effect of identified constructs on plan development and implementation outcomes. Strategic plan quality was affected by engagement (p<.001) and stakeholder representation (p<.01); and implementation was affected by partnership (p<.05). Stakeholder networks and perceptions were also descriptively investigated, finding that criminal justice and social service system affiliates perceived the SIM-W less favorably.

Providers, policymakers, and technical assistance centers can leverage findings to make informed choices, allocate resources effectively, optimize pre-planning, planning, and follow-up support efforts. Researchers can build upon the Strategic Implementation Ecosystem to evaluate the SIM-W as it is applied in diverse settings and towards other target populations. However, as research continues to progress, there is a need to reevaluate and potentially recalibrate the SIM-W to ensure its effectiveness in fostering collaborative efforts and improving outcomes for individuals with BHIs involved in the CJS prior to its ongoing expansion towards different populations.

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