Program Profile: Connections Program (San Diego, Calif.)

This program used coordinated service teams to support mentally ill individuals leaving prison in transitioning back into the community. The program is rated Ineffective. Program participants showed a statistically significant lower likelihood of returning to jail during the program treatment period. However, there were no statistically significant effects on reconvictions during the program treatment period or return to jail at the 6-month follow up.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

The Connections Program used integrated teams of social workers and probation officers to help mentally ill individuals leaving prison reenter the community in San Diego, Calif. Since mentally ill individuals leaving prison often have a much more difficult time accessing community services to assist them in meeting the condition of probation or parole, the Connections Program sought to overcome this by providing them with immediate assessment and long-term, continuous aftercare following release from jail. The program was based on principles of assertive community treatment (ACT) and was designed to provide support to mentally ill individuals leaving prison in transitioning back into the community, with the overall goal of reducing recidivism and decreasing alcohol and/or drug use. Other goals included helping individuals leaving prison become more financially secure, find and maintain stable living situations, and become more capable of meeting their own basic needs.

Target Population/Eligibility

Individuals were eligible for this program if they were in jail or under probation supervision, and had a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I diagnosis and Global Assessment of Function Axis V score of greater than 50, as well as serious symptoms or impairment.

Key Personnel

Each of the intervention teams had a social worker, deputy probation officer, and correctional deputy probation officer.  Each team served a maximum of 30 clients at any one time. Other program support staff included consulting psychiatrists and an employment specialist.

Program Components

The program used integrated teams of social workers and probation officers, with a staff-to-client ratio of 1:10, to provide long-term, continuous care to clients. Other components of the program included 24-hour staff availability, pre-release treatment planning, linkages to community-based interventions, a payee program to assist clients in managing finances, and case management that focused on long-term stability. Clients received services for 9 to 12 months after they were released from jail.

There were five phases of treatment: 1) pre-release, which involved preliminary service planning for the client after release; 2) engagement and assessment, which involved regular, continuous contact between team members and clients and occurred over 3 months; 3) support and monitoring, which involved continued client–team contact and occurred over a second 3-month period; 4) transfer of care, which involved planning for post-program support and occurred over a third 3-month period; and 5) discharge versus continuation of services, which involved determining if a client was ready to exit the program. The intensity of services was expected to reduce during the intervention as individuals became more stable and were linked to resources over time.

Other Information

The program was implemented from June 2000 to December 2003. The program was ended due to budgetary restraints (Burke and Keaton 2004).

Study

Burke and Keaton (2004) conducted a randomized controlled trial to study the impacts of the Connections Program on mentally ill inmates who were in jail or on probation. The program lasted from June 2000 to February 2003 in San Diego, Calif., where randomly assigned mentally ill individuals leaving prison received a coordinated support team to help with the successful transition from incarceration to community.

Participants eligible for this study were currently in jail, under probation supervision, and had a DSM-IV Axis 1 diagnosis or a Global Assessment of Function Axis V score of greater than 50. A score greater than 50 indicated the individual had serious symptoms or serious impairment in social, occupational, or school functioning. A six-phase process was used to identify potential study participants, including a review of their psychiatric diagnoses and an in-depth screening and intake interview.

Clients in the intervention program received services between 9 to 12 months after release from jail. The comparison group received treatment-as-usual in a jail setting; the degree and intensity of these services were dependent on individuals’ willingness to participate and receive services. After release from jail, the comparison group was dependent on the level of probation supervision they received. The majority received mid-level support, which consisted of seeing their probation officer once and being provided with a reference list to available community services.

A total of 449 individuals leaving prison participated in the study, with 225 were assigned to the intervention group and 224 assigned to the comparison group. More than half of the intervention group was male (55 percent). The ethnic background of the intervention group was 56 percent white, 27 percent Black, 12 percent Hispanic, and 6 percent other ethnicity. The ethnic breakdown of the comparison group was 57 percent white, 22 percent Black, 9 percent Hispanic, and 12 percent other ethnicity. The average age for the intervention group was 36.2 years, while the average age for the comparison group was 34.2 years. No statistical adjustments on baseline characteristics were indicated in the analysis of the study.

The main outcome of interest was recidivism (measured as new bookings and convictions). Data on the outcomes of returning to jail during treatment, reconviction during treatment, and return to jail within 6 months after release was collected from the San Diego Sheriff’s Department database. Interviews were conducted with clients at program exit and at 6 months following the program completion. The follow-up period lasted until the date of exit from the program (which included a possible 3-month extension) for the intervention group, and 1 year from release for the comparison group, and again at 6 months after completion of the program. Subgroup analyses were conducted to determine the potential effect of program completion on outcomes of interest.

In April 2000, the intervention teams began intensive training that focused on seven areas that ensured that the team had the skills to successfully collaborate and apply the support team model. The team members learned about other team members’ roles and background; safety, including first aid, field officer safety, safe driving, and ride-along experience; clinical issues such as mentally ill incarcerated persons, medications, family outreach, and substance use; assessment and research documentation; tours and field trips, so that teams could familiarize themselves with facilities and support services; general reference reading; other active learning activities; and supplemental training, especially on substance use characteristics and treatment (Burke and Keaton 2004). 

Monthly training was also offered to the teams to address specific and timely issues. These monthly trainings continued to provide openings for staff to understand their clients and the support services offered by the community.

Burke and Keaton (2004) conducted subgroup analyses to determine the potential effect of program completion on outcomes of interest. At the 6-month follow up, results indicated that Connections participants who successfully completed the program showed a statistically significant lower likelihood of returning to jail and a decrease in the number of days spent in jail, compared with the comparison group members.

These sources were used in the development of the program profile: