Gary Cuddeback

University of North Carolina at Chapel Hill | UNC

Virtual Reality Job Interview Training (VR-JIT) has increased employment rates for returning citizens when added to a successful prison-based employment readiness program. However, implementation preparation cost—expenses prior to offering VR-JIT to intended recipients—is unknown. We estimated the cost of implementation preparation activities (e.g....

Little research exists about PTSD and traumatic experiences among justice-involved individuals with mental illnesses and how those experiences differ by race and gender. We examined traumatic experiences and PTSD among 187 individuals with serious mental illnesses on probation in the United States: 94% of participants experienced a traumatic event,...

This exploratory study examines inter-organizational communication patterns and information sharing between probation officers and service providers when coordinating services for people with mental illnesses on probation. Thirty-four probation officers from one rural (n = 12) and one urban (n = 22) county completed a researcher-administered questi...

Although the research on specialty mental health probation (SMHP) is promising, there have been no randomized controlled trials (RCT) of the prototypical model advanced in the research literature and little focus on SMHP implementation. This study assesses the adoption of SMHP in two counties and examines its impact on mental health and criminal ju...

Returning citizens struggle to obtain employment after release from prison and navigating job interviews is a critical barrier they encounter. Implementing evidence-based interview training is a major gap in prison-based vocational services. We conducted a randomized controlled trial (RCT) to evaluate the feasibility and initial effectiveness of Vi...

Assertive community treatment (ACT) is an evidence-based practice for individuals living with severe mental illnesses. Originally conceptualized as a lifetime service, there is a need for standardized measures to help ACT teams identify clients who are potentially ready for a transition to less intensive services. Here, to address this gap in the l...

Background The large and growing number of individuals with severe mental illnesses who are on probation presents challenges to both mental health and criminal justice authorities. The clinical and mental health service needs of probationers with severe mental illnesses have however, been insufficiently researched, particularly with respect to trau...

BACKGROUND Individuals with severe mental illnesses experience high rates of chronic health conditions; however, the extent to which risk of chronic physical health problems varies by race and gender among these individuals is understudied. AIMS This study examines variations in health problems by race and gender among individuals with severe ment...

This paper presents the results of a qualitative study designed to explore and identify the resources that probation officers need to implement specialized mental health probation caseloads, a promising practice that enhances mental health treatment engagement and reduces recidivism among people with mental illnesses. Our research team conducted a...

Understanding the unique health and behavioral health needs of refugees is critical to developing culturally sensitive interventions and services for this vulnerable population. This paper highlights the process of recruiting participants for a study exploring these needs for resettled refugee women from their own perspectives and the perspectives...

Although a growing body of literature has demonstrated that justice-involved people with mental illnesses have criminogenic risk factors at similar or elevated rates as compared to justice-involved people without mental illnesses, more information about how criminogenic risks vary by intensity of mental health symptoms is needed. This information i...

Purpose A formative evaluation examined the acceptability and feasibility of tiny homes for people living with serious mental illness (SMI). Methods The evaluation included four focus groups with people with SMI and service providers ( n = 28) and eight overnight stays with people with SMI. Results The analysis identified six recommendations for...

Background: Alternative payment models, including Accountable Care Organizations and fully capitated models, change incentives for treatment over fee-for-service models and are widely used in a variety of settings. The level of payment may affect the assignment to a payment category, but to date the upcoding literature has been motivated largely i...

Background: The inclusion of indirect spillover costs and benefits that occur in non-healthcare sectors of society is necessary to make optimal societal decisions when assessing the cost effectiveness of healthcare interventions. Education costs and benefits are relevant in the disease area of mental and behavioral disorders, but their inclusion i...

Objective: Justice-involved people with mental illnesses, in general, experience poor criminal justice outcomes (i.e., high rates of recidivism and probation revocations) and are at increased risk of homelessness, unemployment, stigma, trauma, and poor physical health. Low social support is repeatedly associated with worse mental health outcomes i...

Many Assertive Community Treatment (ACT) teams transition consumers to less intensive services as the teams struggle to provide services for new clients, which is a concerning capacity-and-demand issue in many communities. However, evidence regarding such transitions is limited. The purpose of this study was to identify demographic characteristics...

The Michigan Department of Corrections operates the Vocational Village, a skilled trades training program set within a prison that includes an immersive educational community using virtual reality, robotics, and other technologies to develop employable trades. An enhancement to the Vocational Village could be an evidence-based job interview trainin...

Forensic assertive community treatment (FACT) is an adaptation of Assertive Community Treatment (ACT), a widely-studied evidence-based model for mental health services delivery. ACT has been demonstrated to reduce psychiatric hospitalizations and improve community tenure, however, research on the adaptations needed to target criminogenic risks and...

In the United States, the number of justice-involved individuals living with mental illnesses is large and growing; however, there is little information about internalized stigma experienced by this population. To address this gap, we assessed internalized stigma and its relationship with symptomatology and demographic and clinical characteristics...

Background: Specialty mental health probation (SMHP) is designed to improve outcomes for the large number of people with serious mental illnesses who are on probation and/or parole. The evidence for specialty mental health probation is promising; however, little is known about the implementation challenges and facilitators associated with SMHP. To...

Nationally representative data on mental health disorder prevalence are critical to set informed mental health priorities and policies. Data indicating mental health diagnoses within our nation’s veteran population treated at the Veterans Health Administration (VHA) are available, but have yet to be examined for changing trends to inform both VHA a...

Objective: With nearly 11 million people in the United States arrested in 2015, the need to identify antecedent risk factors driving criminal justice involvement (CJI) and possible mitigating factors is crucial. This study examines the relation between childhood trauma and CJI in adolescence and adulthood and assesses how this relation is moderate...

Individuals who have committed sex offenses (ISOs) with severe mental illnesses are a complex population to serve and more research is needed to guide practice and policy, especially around community supervision, enrollment in Medicaid, housing, employment, criminal justice contacts, and reincarceration after prison reentry. To further the literatu...

Adults released from incarceration are at high risk of death from drug-related causes, pointing to the importance of connecting individuals to healthcare services after release from prison. Though Medicaid plays an important role in financing behavioral health treatments for vulnerable groups, many states terminate individuals’ Medicaid coverage du...

This article reports the findings of a 2-day public health social work (PHSW) summit that brought together PHSW educators, practitioners, and administrators to generate ideas for preparing the next generation of PHSW leaders. Data from focus groups revealed four themes: the importance of PHSW in our healthcare delivery system, the need for public h...

Objective To examine whether the receipt of timely mental health services is associated with changes in criminal justice interactions. Data Sources We used linked administrative data from Medicaid, mental health, and criminal justice settings in Washington State for persons with severe mental illness released from prison (n = 3086). Study Design...

Objectives Describe to what extent case workers identify their professional role as behavioral health care managers, and variation based on individual characteristics. Method We used data from the 2008–2011 National Survey of Child and Adolescent Well-Being II to describe child welfare case workers' perceived responsibility for the care management...

There is little published information about the measures that probation agencies in the United States use to identify individuals with mental illnesses who are under community supervision. This study used statewide administrative data to estimate and compare the prevalence of mental illnesses among probationers using officer report and offender sel...

Low executive function (EF) and depression are each determinants of health. This study examined the synergy between deficits in EF (impaired cognitive flexibility; >75th percentile on the Wisconsin Card Sorting Test perseverative error score) and depressive symptoms (modified Centers for Epidemiologic Studies–Depression) and preincarceration well-b...

Women with severe mental illnesses face high rates of violence victimization, yet little is understood about the unique needs and challenges these women present to the domestic violence and behavioral health agencies that serve them. To help address this knowledge gap, focus groups were conducted with 28 staff members from local behavioral health a...

An emerging focus of Assertive Community Treatment (ACT) teams is the transition of clients to less intensive services, which creates space for individuals in need of ACT and is consistent with a recovery orientation of treatment. However, there is limited research on team transition rates, post-ACT services, and strategies to overcome transition b...

A Handbook for the Study of Mental Health - edited by Teresa L. Scheid June 2017

As compared with the general population, women with serious mental illness experience higher rates of intimate partner violence, sexual assault, and are at a greater risk of future victimization, post-traumatic stress disorder, exacerbated symptoms of mental illness, and other negative health outcomes. Despite substantial research, the field lacks...

Objective This article introduces Bayesian assurance as an alternative to traditional power analysis in intervention research. Bayesian assurance is defined as the unconditional probability of identifying an intervention effect. Method Assurance can be calculated as the expected statistical power based on a prior distribution of the unknown parame...

This chapter reviews the scope and epidemiology of the problems of mental health worldwide including the epidemiological transition from acute to chronic disease and increased focus on conditions that debilitate, including psychological problems. Chief among these are depression, anxiety disorders, substance use disorders, personality disorders, ps...

Background The large and growing number of probationers with mental illnesses pose significant challenges to the probationer officers who supervise them. Stigma towards mental illnesses among probation officers is largely unstudied and the effectiveness of training initiatives designed to educate probation officers about mental illness is unknown....

Background Adults with co-occurring mental and substance use disorders (CODs) are overrepresented in jails. In-custody barriers to treatment, including a lack of evidence-based treatment options and the often short periods of incarceration, and limited communication between jails and community-based treatment agencies that can hinder immediate enro...

Large urban jails have become a collection point for many persons with severe mental illness. Connections between jail and community mental health services are needed to assure in-jail care and to promote successful community living following release. This paper addresses this issue for 2855 individuals with severe mental illness who received commu...

Topic: Although individuals with medical problems (e.g., diabetes, hypertension) can monitor their symptoms using objective measures (e.g., blood glucose, blood pressure), objective measures are not typically used by individuals with psychotic disorders to monitor symptoms of mental illness. Purpose: To examine the benefits and limitations of th...

Objective: This study examined long-term outcomes (at 36 months) from Washington State's policy of expediting Medicaid enrollment for prison releasees with severe mental illness and compares them with previously reported short-term outcomes (at 12 months). Methods: Linked administrative data on prison releasees (2006-2007) were analyzed by using...

As part of a larger study of probation workload and workforce challenges in one southeastern state, this study reports the results from a statewide survey of probation officers’ experiences supervising probationers with mental illness. A total of 615 officers responded to closed- and open-ended questions about the challenges and barriers to supervi...

We sought to explore clinical factors associated with successful transition from Assertive Community Treatment to less intensive clinical services. Mixed-method observational follow up study of veterans discharged from three VA-affiliated ACT teams to less intensive clinical services. Of the 240 veterans in ACT, 9% (n = 21) were discharged during t...

Objective: More information is needed about the financial experiences of justice-involved persons with severe mental illness. Methods: Qualitative and quantitative methods were used to examine the financial resources, financial risk experiences, and financial literacy of a random sample of 12 mental health court participants. Results: Mental health...

There are more than 2,500 Crisis Intervention Teams (CIT) in operation across the country. Results of research on the effectiveness and impact of CIT are mixed. One aspect of CIT training that has yet to be examined is the expert-derived suggestion that 40 consecutive hours of training is an essential element of CIT for law enforcement officers. Th...

Objective: This study investigated whether Washington State's 2006 policy of expediting Medicaid enrollment for offenders with severe mental illness released from state prisons increased Medicaid access and use of community mental health services while decreasing criminal recidivism. Methods: A quasi-experimental design with linked administrativ...

Objective: This study examined postrelease patterns of Medicaid coverage and use of services among persons with severe mental illness who were referred for expedited Medicaid enrollment before their release from state prisons, county jails, and psychiatric hospitals in Washington State during 2006, the first year of a new policy authorizing this p...

Objectives: To identify trends in compounding pharmacies with a focus on women's health and, more specifically, the types and combinations of medications used in the treatment of vulvodynia. Methods: This survey study was conducted with 653 nonchain pharmacies that compound medications. Each pharmacy was asked to complete a 19-item online survey...

Community reentry for persons with mental illness released from jails and prisons is one of the most pressing public health and public safety challenges today. To address this challenge, Washington State has expedited Medicaid restoration for mentally ill persons released from state prisons to facilitate access and utilization of services upon rele...

Objective: More research is needed about forensic assertive community treatment (FACT) and challenges that offenders with severe mental illness present to jail diversion and prison reentry teams. Jail diversion and prison reentry populations may require different interventions and strategies to engage and serve them. Methods: This study used dat...

Background: A number of states have implemented Assertive Community Treatment (ACT) teams statewide. The extent to which team-based care in ACT programs substitutes or complements primary care and other types of health services is relatively unknown outside of clinical trials. Objective: To analyze whether investments in ACT yield savings in pri...

When first conceptualized, it was thought that individuals with severe mental illness who needed assertive community treatment (ACT) would need ACT for life. Today, ACT-for-life is contrary to recovery-based principles, and teams routinely transition consumers to less intensive services. However, there is little qualitative information about the ex...

There is an on-going concern that reductions in psychiatric inpatient bed capacity beyond a critical threshold will further exacerbate the incarceration of persons with mental illness. However, research to date to assess the proposed relationship between inpatient bed capacity and jail use has been limited in several ways. In addition, mechanisms t...

Objective: A previous study of recovery-oriented assertive community treatment (PACT) found large differences over three years in use of state psychiatric hospitals between PACT participants and consumers in a matched control group, especially for PACT participants with significant previous psychiatric hospitalization. This study extended these fi...

Objective: A previous study of a recovery-oriented assertive community treatment initiative (PACT) in Washington State found reductions in state psychiatric hospital use and related costs for PACT participants, especially in the first six months after enrollment and for consumers who were high users of the state psychiatric hospital before ACT enr...

Objective: The purpose of this study was to assess the effectiveness of Washington State's PACT, a recovery-oriented assertive community treatment (ACT) initiative, in reducing state psychiatric hospital use. Methods: A quasi-experimental design and administrative data were used to compare 450 PACT consumers and 450 propensity score-matched cons...

Assertive community treatment (ACT) has been a widely used intervention for persons with severe mental illness for over 30 years. One of the latest adaptations of ACT incorporates a recovery and person-centered orientation into its traditional practices. This presentation reports on an evaluation of Washington State's PACT initiative where 10 recov...

Keeping people with severe mental illnesses out of the criminal justice system is a pressing public health and public safety issue facing many communities today. Mental health courts (MHCs) have proliferated rapidly as a jail diversion strategy for persons with severe mental illnesses; however, low graduation rates and poor outcomes have been linke...

The loss of Medicaid is a primary barrier to successful community reintegration for persons with severe mental illness who are released from jails, prisons and state hospitals. Several states have adopted expedited Medicaid restoration programs to reconnect consumers to their benefits prior to release from institutional settings; however, the impac...

Evidence-based practice must include the translation of research into practice, and the social work practitioner is the essential link in that translation. As part of the EBP process, researchers must present findings in a way that is accessible to practitioners and practitioners must view the study as relevant and representative of their clients’...

The evidence for forensic assertive community treatment (FACT) is promising; however, a number of gaps in our knowledge about FACT remain. For example, only one study in the extant literature includes the perspectives of FACT consumers and more information about what consumers like and/or dislike about FACT is needed. To address this gap in our kno...

Evidence-based practice must include the translation of research into practice, and the social work practitioner is the essential link in that translation. As part of the EBP process, researchers must present findings in a way that is accessible to practitioners and practitioners must view the study as relevant and representative of their clients'...

Despite the high prevalence of substance use disorders (SUDs) in the U.S., many with a SUD go untreated and/or report lengthy delays to help-seeking initiation. From a public health standpoint, because SUDs often emerge in early adulthood, information on help-seeking behaviors among young adults is important. Using data from young adults ages 18-23...

Assertive community treatment (ACT) is characterized as a service delivery platform and represents an ideal setting in which mental health and physical health care can be integrated. Little is known about the extent to which ACT integrates physical health care with mental health care or the challenges ACT teams experience. To address this gap, focu...

Forensic assertive community treatment (FACT) is a recent adaptation of the assertive community treatment (ACT) model; however, more information is needed about how FACT and ACT consumers differ and how FACT should be modified to accommodate these differences. Linked, multisystem administrative data from King County, Washington, were used to compar...

This study examined whether the proportion as well as the number of prisoners with behavioral health disorders have increased in recent years. Among 41,440 persons admitted to Washington State prisons from 1998 through 2006, this study estimated numbers and proportions of behavioral health disorders diagnosed while persons were in the community or...

At-risk adolescents experience troubling levels of depression but there is a dearth of research related to the levels of depression and associated psychosocial problems experienced by adolescent abortion patients. The relationship between depression and 16 other psychosocial life problems is examined in a sample of adolescent pregnancy termination...

Emergency medical services transport and emergency department misuse among persons with behavioral health conditions is a concern. Administrative data were used to examine medical transports and hospital admissions among persons with behavioral health conditions. Data on 70,126 medical transports to emergency departments in three southeastern count...

Jail diversion and forensic community treatment programs have proliferated over the past decade, far outpacing evidence regarding their efficacy. The current study reports findings from a randomized clinical trial conducted in California for frequent jail users with serious mental illness that compares a forensic assertive community treatment (FACT...

Individuals with severe mental illnesses (SMI) are a vulnerable population, struggling to cope with fragmented and often unwelcoming community service systems. Research has examined Assertive Community Treatment (ACT) as an intervention for SMI individuals, but little research has explored ACT's potential as a community system change intervention....

Persons with severe mental illness have higher rates of chronic general medical illness compared with the general population. Similarly, compared with the general population, incarcerated persons have higher rates of chronic medical illness; however, there is little information about the synergy between severe mental illness and incarceration and t...

Limited information currently exists about forensic assertive community treatment (FACT) and how it serves persons with mental illness involved with the criminal justice system. This study screened 28 forensic mental health programs to identify 12 FACT teams for site visits about their consumers, their interface with the criminal justice system, an...

Despite the growing interest in forensic assertive community treatment (FACT), there is no standardized definition of FACT eligibility and no guidelines for how many FACT teams communities may need. In this brief report a definition for FACT eligibility is proposed-severe and persistent mental illness and three jail detentions in a one-year period-...

Despite the growing interest in forensic assertive community treatment (FACT), there is no standardized definition of FACT eligibility and no guidelines for how many FACT teams communities may need. In this brief report a definition for FACT eligibility is proposed - severe and persistent mental illness and three jail detentions in a one-year perio...

This paper presents an overview of Assertive Community Treatment (ACT) as an evidence-based practice in mental health care. We then consider current evidence for FACT (ACT for forensic populations) and FICM (intensive case management for forensic populations) and the ways these models have been extended and adapted to serve mentally ill persons in...

This study sought to determine whether having Medicaid benefits and receiving behavioral health services are associated with a reduction in recidivism for jail detainees with severe mental illness. A quasi-experimental design with linked administrative data was used. All persons released over a two-year period from jails in King County, Washington...

A better understanding of kinship foster families' perceptions of the familial factors and parenting beliefs that promote or inhibit successful fostering can inform child welfare practice and policy. To this end, and to extend previous research [Buehler, C., Cox, M. E., and Cuddeback, G. (2003). Foster parents' perceptions of factors that promote o...

Objective: The Casey Foster Applicant Inventory-Applicant Version (CFAI-A) is a new standardized self-report measure designed to assess the potential to foster parent successfully. The CFAI-A is described, and results concerning its psychometric properties are presented. Method: Data from a sample of 304 foster mothers from 35 states are analyzed....

Objective: This article examines the psychometric properties of the Casey Foster Applicant Inventory-Worker Version (CFAI-W), a questionnaire designed to assess the potential of foster family care applicants to provide foster care. Method: Retrospective data were collected from 208 foster care workers who completed two copies of the CFAI-W, one for...

Assertive community treatment (ACT) reduces hospitalizations for persons with severe mental illness. However, not everyone who needs ACT receives it. Without empirical guidelines for ACT planning, communities are likely to underestimate or overestimate the number of teams they need; thus the capacity of the programs will not meet current needs. In...

This prospective cohort study in two large metropolitan jail systems examined whether Medicaid disenrollment policies for persons detained in jail were enforced. The extent to which persons with severe mental illness lost their Medicaid benefits while detained was determined. Mailed questionnaires to state Medicaid directors in 2000 yielded a 95 pe...

This study assessed the extent to which Medicaid enrollment increased access to and use of services by persons with severe mental illness after their release from jail. A prospective cohort design was used that linked administrative data from several agencies in two large urban areas: King County (Seattle) from 1996 to 1998 and Pinellas County (Cle...

The potential to foster successfully starts with developing and supporting competency in 12 domains: providing a safe and secure environment, providing a nurturing environment, promoting educational attainment and success, meeting physical and mental healthcare needs, promoting social and emotional development, supporting diversity and children's c...

Virtually nothing is known about the characteristics used to select foster families. This study examined if and how psychosocial problems, income, education, race and the supply of and demand for foster families are related to the approval of families to foster and the placement of children. Families who were approved and who had a child placed had...