Ninety percent of NACBHDD members (607 of 676 members) responded to the Web-based survey. They identified 61 programs of which 27 met FACT study criteria. Fifty-six percent of programs meeting FACT criteria (15 of 27 programs) reported incorporating close working relationships with probation officers. Thirteen of the 15 (87%) FACT programs began operation on or after 1998 (appendix B at ps.psychiatryonline.org
). The programs received patient referrals from multiple sources, most commonly local jails (appendix C at ps.psychiatryonline.org
). Of patients across all programs, 70%±14% were men, 55%±28% had diagnoses of schizophrenia or schizoaffective disorder, 25%±20% had bipolar disorder, and 77%±33% had a co-occurring substance use disorder. In addition to having axis I diagnoses, 20%±21% of patients had an axis II diagnosis of antisocial personality disorder and 66%±38% had antisocial personality traits. An average of 61%±39% of patients were homeless upon admission to the FACT program, and 40% of programs (six of 15) incorporated residential services to assist homeless clients.
Twelve programs (80%) required a history of misdemeanor arrests or convictions for admission to FACT, and 11 programs (73%) admitted patients with histories of violent crime. Programs reported that 93%±15% of patients had previously been in jail or prison, 47%±34% had previous felony convictions, and 23%±22% had histories of violent crimes, such as murder, rape, and assault. Programs also reported that an average of 75%±27% of patients were on probation and that 16%±29% were on parole when admitted to their respective FACT programs. Only two programs reported using standardized risk assessment tools such as the Level of Service Inventory (10
) to assess the risk of future criminal recidivism.
Probation officers had worked in their respective FACT programs an average of 4.5±3.8 years at survey time. They attended an average of 57%±42% of treatment team meetings across all programs, and 87% of programs (13 of 15) described the officers as actual treatment team members. Most programs (73%, N=11) noted that their collaborating probation officers had received some form of mental health training, usually brief educational sessions conducted by state or local mental health organizations. [Appendix D at ps.psychiatryonline.org
provides details about the training, time commitments, and funding of FACT program probation officers.]
Probation officers worked in the FACT programs an average of 29±16 hours per week. Nine FACT programs (60%) had a full-time probation officer. According to program representatives, the four primary responsibilities of probation officers were serving as a court liaison; obtaining collateral information, including criminal records; performing drug testing; and performing community outreach. Two-thirds of probation officers performed community outreach in conjunction with team clinicians. Probation officers were generally assigned only patients on the team who were serving probation sentences. Four programs (27%) noted that their probation officers also provided input to team clinicians about other patients, usually patients who had previously been on probation.
Program representatives reported high levels of agreement between clinicians and probation officers about when to use legal sanctions, such as arrest or incarceration. Ten (67%) reported that they usually agreed, three (20%) reported that they always agreed, and two (13%) programs reported that they sometimes agreed. Program representatives also reported a positive (seven of 15 programs, 47%), very positive (six programs, 40%), or neutral (one program, 7%) impact of probation involvement on their patients’ risk of rearrest. One program in its first year of operation reported that having a probation officer on the team increased patients’ risk of arrest and hospitalization. Of the nine programs with a full-time probation officer, perceptions regarding levels of agreement, helpfulness, and risks of arrest and hospitalization followed a distribution similar to that in the programs with part-time probation officers.
The most commonly reported barrier to effective collaboration reported in 73% of programs (11 of 15) was a difference in the philosophy and approach of FACT program clinicians and probation officers. Program representatives generally described clinicians as being more health oriented and diplomatic with patients, whereas they described probation officers as more public safety oriented and directive with patients. One team struggled to keep roles clear yet integrated; the mental health staff took on a monitoring role, and the probation officer functioned more as a case manager. Other barriers included limited funding and limited access to probation officers whose primary offices were located off site rather than being colocated with FACT program clinicians. [Additional patient data and study details are provided in appendices E and F at ps.psychiatryonline.org