< Previous20 PERSPECTIVESVOLUME 46, NUMBER 3 INFORMATION PROCESSING MATTERS Incarceration poses risk for additional traumatic experiences for those involved in the justice system. Wolff and colleagues (2007) found that incarcerated individuals with a history of sexual victimization prior to prison were three to five times more likely to experience sexual victimization while incarcerated compared to their incarcerated counterparts with no such prior victimization experience. Research also demonstrates elevated risk of trauma exposure during incarceration for marginalized groups within the justice-involved population, to include transgender individuals, non- heterosexual individuals, and mentally ill individuals. For example, sexual victimization surveys administered by the Bureau of Justice Statistics to self-identified transgender respondents in federal prisons and jails found that 34.6% of transgender individuals in prison reported sexual victimization within the preceding 12 months or since being incarcerated if they had been in prison less than one year (Beck, 2014). Similarly, the 2008 National Former Prisoner Survey found that more than one-third of non-heterosexual males reported being sexually victimized by another inmate during their most recent period of incarceration compared to 3.5% of heterosexual males (Beck & Johnson, 2012), while the 2011-2012 National Inmate Survey found that staff-on- inmate victimization rates were at least double for non- heterosexual inmates compared to heterosexual inmates. Finally, prison inmates with serious psychological distress (SPD) experienced rates of victimization that were nine times higher than prison inmates without mental health problems, while jail inmates with SPD experienced rates of victimization that were five times higher than jail inmates without mental health problems (Beck et al., 2013). Association with Criminogenic Risk Factors and Responsivity to Correctional Interventions Discussions regarding whether trauma should be identified as a criminogenic risk factor or a responsivity factor within the RNR model continue among researchers and practitioners, with proponents of including trauma as a risk factor pointing to studies showing an association between trauma and offending and opponents of including trauma as a responsivity factor suggesting that the relationship to offending is indirect via its impact on criminogenic risk factors (Vitopoulos et al., 2018). The primary criminogenic risk factors outlined within the RNR model have been labeled the Central Eight and include: prior history of antisocial behavior, associations with antisocial peers, endorsement of antisocial attitudes, presence of antisocial personality pattern, school and work performance difficulties, substance abuse, family and/or marital difficulties, and lack of prosocial leisure and recreation (Bonta & Wormith, 2013). Trauma exposure has been empirically associated with many of these factors. For example, there is empirical evidence of an association of childhood trauma and the development of antisocial personality disorder (Bruce & Laporte, 2015; Krastins et al., 2014), and the association of trauma exposure and consequent substance abuse is well established (Mergler et al., 2018). Childhood maltreatment has been associated with peer rejection, which can lead to reduced participation in prosocial leisure activities and may also result in seeking out associations with antisocial peers (Yoon, 2020). Research has also shown that childhood maltreatment is associated with poor school and work performance, disruptive behaviors at school, school dropout, reduced workforce participation, and employment termination (Bellis et al., 2013; Kim & Cicchetti, 2010; Porche et al., 2011; Sansone et al., 2012; Tam et al., 2003; Zielinski, 2009). Trauma’s impact on the brain can interfere with the ability to fully participate in and benefit from correctional interventions. Difficulty concentrating, memory problems, racing thoughts, difficulty making decisions, magical thinking, irritability or hostility, and mood swings are all examples of the brain’s reaction to trauma (SAMHSA, 2014b). Each of these reactions can negatively impact program compliance, adherence to supervision conditions, participation in treatment groups, interactions with other program participants, and interactions with correctional staff. Trauma exposure and associated symptoms are also associated with premature treatment dropout for both adults and adolescents (Jaycox et al., 2004). Evidence of Trauma- Informed Approaches Before discussing the evidence in support of trauma- informed approaches, it is important to note the distinction between trauma-informed care and trauma- specific services or treatment. Most notably, trauma- informed care is not specifically designed to address consequences of trauma or to provide relief from trauma 21 AMERICAN PROBATION AND PAROLE ASSOCIATION INFORMATION PROCESSING MATTERS symptoms. Rather, the focus is to prevent or decrease revictimization or triggering of previous traumas for individuals served or supervised by correctional and/ or treatment agencies (often referred to as correctional clients or clients). To that end, trauma-informed care is the responsibility of all staff within the organization who interact with correctional clients as well as of administrators who design policies and procedures even if they do not have direct interaction with clients. Trauma- specific treatment, on the other hand, uses evidence- based techniques to address traumatic stress and any associated co-occurring disorders (e.g., substance use disorder or mental illness) to improve symptomology and to mitigate adverse consequences associated with unresolved traumatic stress. Unlike trauma-informed care, trauma-specific treatment requires specific clinical training and competence to deliver. To date, fewer studies have been conducted assessing the impact of trauma-informed care compared to trauma- specific treatment; however, there is some research demonstrating that trauma-informed care is associated with increases in successful treatment completion, staff and client satisfaction, positive staff perceptions of organizational climate, and reductions in client misconduct and use of physical restraints (e.g., Elwyn et al., 2015; Hales et al., 2019). Studies of trauma-specific treatment are greater in number, have largely focused on youth and women, and have found that such treatment can effectively treat traumatic stress symptomology (DeCandia et al., 2014). Examples of evidence-based treatment approaches include, but are not limited to, Trauma-Focused Cognitive Behavioral Therapy (Cohen et al., 2006), Seeking Safety (Najavits, 2002), Prolonged Exposure Therapy, Cognitive Processing Therapy (Monson et al., 2006), Trauma Affect Regulation: Guide for Education and Therapy (TARGET) (Ford & Hawke, 2012), Eye Movement Desensitization and Processing (EMDR) (Shapiro, 1995), Helping Women Recover (Covington, 2012, rev. 2019), Beyond Trauma (Covington, 2016), Beyond Violence (Covington, 2015), Healing Trauma: A Brief Intervention for Women (Covington & Russo, 2011, rev. 2016), and Exploring Trauma: A Brief Intervention for Men (Covington & Rodriguez, 2016). Addressing Trauma in Practice While trauma may be a past event, its impact often continues into the present and manifests in ways that work against justice-involved individuals’ success in programs. Consequently, agencies whose missions include long-term behavior change (i.e., recidivism reduction) and not just mere compliance with organizational or supervision rules have a vested interest in mitigating the detrimental impact of trauma. Consequently, this section will outline some practical strategies for consideration by professionals working with justice-involved individuals. These strategies will be categorized as either trauma-informed care or trauma- specific services/treatment, the categories already described in the previous sections. Given the prevalence of trauma exposure and PTSD among justice-involved individuals, it is likely that practitioners are routinely interacting with individuals who have been negatively impacted by exposure to trauma (McAnallen & McGinnis, 2021), making universal precautions approach necessary. A universal precautions approach simply means that staff should interact with each individual as if that person has experienced trauma. To that end, we will start with strategies that all staff can and should deploy with all individuals on supervision and will first focus on strategies pertinent to trauma-informed care. We focus here first as all staff are capable of using trauma-informed care strategies with appropriate training. Physical Environment Trauma-informed design of physical spaces can promote a sense of safety and de-escalation. While agencies may not have complete control over the layout of facilities, aspects of the physical environment that can impact a sense of safety and trust should be assessed and adjusted as needed and to the extent possible. One example that is typically within full control of an agency is internal signage used to communicate rules and policies to correctional clients. Signs that rely on bolded words printed in all capital letters can be overstimulating and give the impression that the agency is yelling at individuals via its signs. Similarly, posted rules that rely primarily on negative command statements beginning with the words “do not” may be perceived as paternalistic and failing to acknowledge the autonomy of correctional clients. In addition, homemade signs posted on staff doors or office walls with sarcastic quotes such as “a lack of planning on your part does not constitute an emergency on my part” convey a message that staff are not fully accessible and may present a barrier to individuals seeking help. (As an incidental note on this “lack of planning” issue, alternative cognitive-behavioral 22 PERSPECTIVESVOLUME 46, NUMBER 3 INFORMATION PROCESSING MATTERS approaches can be used to teach skills related to problem-solving, time management, and recognizing and respecting time boundaries for individuals who exhibit patterns of unscheduled visits requiring assistance.) In addition to agency signage, the basic decor of the space should also be evaluated for its impact. For example, stark white walls and bright white lights produce an institutional look that may activate unpleasant emotions and reduce feelings of safety. Efforts to make office spaces more welcoming for justice-involved individuals include: (a) limiting the number of instructional signs to only those that are necessary, so as to minimize overwhelming individuals, and limit use of bold and/ or capital letters; (b) reframing instructions and rules in positive language, such as revising “do not turn payments in late” to “please turn all payments in on time” to emphasize autonomy; (c) eliminating any signage that signals a lack of empathy and a punitive response to individuals in need of assistance; (d) using light, calming wall colors, and natural or dimmable lights to promote a sense of less crowding and more openness; and (e) including plants or landscape art in the office décor, as spaces with such décor have been associated with lower levels of stress (Largo-Wight, 2011). Staff Communication Practices In addition to the prevalence of trauma exposure, correctional agencies typically work with a population of individuals with a high prevalence of prolonged substance use and lower literacy levels (Bronson et al., 2020; Mellow & Christian, 2008). Each of these impacts the ability of individuals to take in, process, and retain information. Consequently, correctional staff should be diligent in using simple techniques to maximize the likelihood that the individuals they serve adequately understand all of the rules and conditions of supervision and treatment. These techniques include: (1) avoidance of professional jargon and acronyms; (2) presenting information in smaller quantities by limiting the number of topics or rules covered at one time; and (3) using teach- back methods in which individuals are asked to repeat what has been discussed in their own words so that staff can check for understanding. Given that respectful communications and interactions are foundational to evidence-based teaching approaches aimed at recidivism reduction (e.g., cognitive-behavioral and social learning approaches), staff use of person-first language should be a minimum standard with all justice-involved individuals. This means using language that emphasizes the person rather than the behavior or status (e.g., the label of offender or criminal is based on the status of committing illegal behavior), as language that focuses on labels may serve to further marginalize individuals and convey a message that they cannot change (McCartan et al., 2019). Related is the elimination of derogatory terminology in favor of factual, objective terminology to describe individuals, processes, and outcomes. A notable example is the use of such pervasive phrases as “dirty urine” and “clean urine” rather than simply describing drug test results with factual language such as “positive test results” and “negative test results.” Core Correctional Practices and Motivational Interviewing Consensus exists that trauma-informed correctional environments should include respectful, collaborative alliances with staff, a focus on skill building and building self-efficacy, consistency in rules and expectations, emphasis on choice and autonomy, and experiential learning (e.g., Levenson & Willis, 2018). Fortunately, a set of evidence-based practices already widely used in corrections to reduce recidivism aligns well with these trauma-informed practices; these practices are collectively known as Core Correctional Practices, or CCPs (Dowden & Andrews, 2004). Examples of CCPs that align with trauma-informed approaches include: (a) staff relationship qualities and skills that include warm, respectful, and empathic relationships with correctional clients that rely on nonjudgmental, solution-focused styles of communication; (b) effective use of authority involving a “firm but fair” approach that focuses on behavior rather than the person and provides choices and accompanying consequences; (c) staff modeling and reinforcement of prosocial skills and behaviors; (d) use of structured learning procedures to model and teach skills and to provide constructive feedback; (e) teaching problem-solving skills; (f) effective use of disapproval skills; and (g) brokerage of community services and resources on behalf of correctional clients (Dowden & Andrews, 2004). Use of these practices has been shown to produce lower recidivism rates in programs adhering to the RNR model (Dowden & Andrews, 2004). Another evidence-based practice widely used in corrections that also aligns with trauma-informed approaches is motivational interviewing. Motivational interviewing is a “respectful counseling style that 23 AMERICAN PROBATION AND PAROLE ASSOCIATION INFORMATION PROCESSING MATTERS focuses on helping clients resolve ambivalence about and enhance motivation to change” (SAMHSA, 2019, p.1). Motivational interviewing relies on use of open- ended questions, affirmations, reflective listening, and summaries of themes (OARS) and has been shown to improve treatment engagement and retention and to reduce substance use (Blasko et al., 2019). Progressing to Trauma-Specific Screening, Assessment, and Treatment Agencies with the appropriate infrastructure and resources may also opt to implement trauma-specific services for justice-involved individuals. Doing so requires development of an infrastructure to support screening, assessment, and access to evidence-based treatments for trauma symptoms. Decisions related to screening include choice of screening instrument, selection of staff to administer screening instruments, timing of screening, and use of screening results. The timing issue can be important, as clients have yet to establish rapport with staff and obtain a sense of safety when screening occurs at intake. Other considerations related to screening instruments include cost, time and method to administer, requirements to administer, and staff training required. Agencies should also provide procedures for the use of screening results to dictate when and how correctional clients are referred for a full trauma-informed assessment so that a determination can be made as to the need for a referral to trauma-specific treatment. It should be noted that all of this is dependent on the availability of evidence- based treatment options for trauma-specific treatment within the local community, as referring agencies have a responsibility to ensure quality treatment services prior to referral. Conclusion Trauma exposure and traumatic stress are pervasive among justice-involved individuals and at a minimum represent strong responsivity considerations that should be addressed by correctional agencies. It’s also important to acknowledge that trauma-informed approaches are not incongruent with the public safety functions of correctional supervision, and many are aligned with existing evidence-based practices already established for recidivism reduction. While the strategies outlined in this paper do not constitute a comprehensive list of changes required for organizations to implement trauma- informed services and do not adequately convey the organizational will and resources required to implement trauma-informed approaches in corrections, they do provide some concrete examples for consideration within the larger context of a formalized implementation plan for agencies seeking to become more trauma-informed. References Beck, A. J. (2014). Sexual Victimization in prisons and jails reported by inmates, 2011-12 supplemental tables: Prevalence of sexual victimization among transgender adult inmates. Bureau of Justice Statistics, Department Beck, A. J., Berzofsky, M., Caspar, R., & Krebs, C. (2013). Sexual victimization in prisons and jails reported by inmates, 2011-2012: National Inmate Survey, 2011-12. Bureau of Justice Statistics, Department of Justice, NCJ Beck, A. J., & Johnson, C. (2012). National Former Prisoner Survey, 2008: Sexual victimization reported by former state prisoners, 2008. Bureau of Justice Statistics, Bellis, M. A., Lowey, H., Leckenby, N., Hughes, K., & Harrison, D. (2013). Adverse childhood experiences: Retrospective study to determine their impact on adult health behaviours and health outcomes in a UK Blasko, B. L., Viglione, J., Toronjo, H. & Taxman, F. S. (2019). Probation officer-probation agency fit: Understanding disparities in the use of motivational interviewing techniques. Corrections: Policy, Practice Bonta, J., & Wormith, J. S. (2013). Applying the risk-need- responsivity principles to offender assessment. In L. A. Craig, L. Dixon, & T. A. Gannon (Eds.), What works in offender rehabilitation: An evidence-based approach to assessment and treatment (pp. 72-93). John Wiley and Sons. Bronson, J., Stroop, J., Zimmer, S., & Berzofsky, M. (2020). Drug use, dependence, and abuse among state prisoners and jail inmates, 2007-2009. Bureau of Justice 24 PERSPECTIVESVOLUME 46, NUMBER 3 Bruce, M., & Laporte, D. (2015). Childhood trauma, antisocial personality typologies and recent violent acts among inpatient males with severe mental illness: Exploring an explanatory pathway. Schizophrenia Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescent. New York, NY: Guilford. Coleman, D., & Stewart, L. M. (2010). Prevalence and impact of childhood maltreatment in incarcerated youth. American Journal of Orthopsychiatry, 80(3), 343-349. Covington, S. (2015). Beyond violence: A prevention program for criminal justice-involved women participant workbook. Wiley & Sons. Covington, S. (2016). Beyond trauma: A healing journey for women (2nd ed.). Hazelden Publishing. Covington, S. (2022). Creating a trauma-informed justice system for women. In S. L. Brown & L. Gelsthorpe (Eds.), The Wiley Handbook on What Works with Girls and Women in Conflict with the Law: A Critical Review of Theory, Practice, and Policy (pp. 172-184). John Wiley Covington, S. S., & Rodriguez, R. (2016). Exploring trauma: A brief intervention for men. Hazelden Publishing. Covington, S. S., & Russo, R. (2016). Healing trauma: A brief intervention for women (CD-Rom). Hazelden Publishing. DeCandia, C. J., Guarino, K., & Clervil, R. (2014). Trauma-informed care and trauma-specific services: A comprehensive approach to trauma intervention. Washington, DC: American Institutes for Research Dierkhising, C. B., Ko, S. J., Woods-Jaeger, B., Briggs, E. C., Lee, R., & Pynoos, R. S. (2013). Trauma histories among justice-involved youth: Findings from the National Child Traumatic Stress Network. European Journal of Dowden, C., & Andrews, D. A. (2004). The Importance of staff practice in delivering effective correctional treatment: A meta-analytic review of core correctional practice. International Journal of Offender Therapy and Comparative Criminology, 48(2), journals.sagepub.com/doi/10.1177/0306624X03257765 Elwyn, L. J., Esaki, N., & Smith, C. A. (2015). Safety at a girls’ secure juvenile justice facility. Therapeutic Communities: The International Journal of Therapeutic Ford, J. D., & Hawke, J. (2012). Trauma affect regulation psychoeducation group and milieu intervention outcomes in juvenile detention facilities. Journal of Aggression, Fritzon, K., Miller, S., Bargh, D., Hollows, K., Osborne, A., & Howlett, A. (2020). Understanding the relationship between trauma and criminogenic risk using the risk- need-responsivity model. Journal of Aggression, Foy, D. W., Ritchie, I. K., & Conway, A. H. (2012). Trauma exposure, posttraumatic stress, and comorbidities in female adolescent offenders: Findings and implications from recent studies. European Journal of Psychotraumatology,3(1), 17247. https://doi.org/10.3402/ Gibson, S. (2011). Trauma and life event stressors among young and older adult prisoners. Journal of Correctional Health Care, 17(2), 160-172. https://doi. A., Diebold J., Koury, S. P., & Nochajski, T. H. (2019). Trauma informed care outcome study. Research on Social Work Practice, 29(5), 529-539. https://doi. 25 AMERICAN PROBATION AND PAROLE ASSOCIATION INFORMATION PROCESSING MATTERS Jaycox, L. H., Ebener, P. A., Damesek, L., & Becker, K. (2004). Trauma exposure and retention in adolescent substance abuse treatment. Journal of Traumatic Kim, J., & Cicchetti, D. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Krastins, A., Francis, A. J. P., Field, A. M., & Carr, S. N. (2014). Childhood predictors of adulthood antisocial personality disorder symptomatology. Australian Komarovskaya, I. A., Loper, A. B., Warren, J., & Jackson, S. (2011). Exploring gender differences in trauma exposure and the emergence of symptoms of PTSD among incarcerated men and women. The Journal of Forensic Psychiatry & Psychology, 22(3), 395-410. Largo-Wight, E. (2011). Cultivating healthy places and communities: evidenced-based nature contact recommendations. International Journal Levenson, J. S., & Willis, G. M. (2018). Implementing trauma-informed care in correctional treatment and supervision. Journal of Aggression, Maltreatment & McAnallen, A., & McGinnis, E. (2021). Trauma-informed practice and the criminal justice system: A systematic narrative review. Irish Probation Journal, 18, 109-128. McCartan, K.F., Harris, D.A., & Prescott, D.S (2019). Seen and not heard: The service user’s experience through the justice system of individuals convicted of sexual offenses. International Journal of Offender Therapy and Comparative Criminology, 65(12), 1299- Mellow, J., & Christian, J. (2008). Transitioning offenders to the community: A content analysis of reentry guides. Mergler, M., Driessen, M., Havemann-Reinecke, U., Wedekind, D., Lüdecke, C., Ohlmeier, M., Chodzinski, C., Teunißen , S., Weirich, S., Kemper, U., Renner, W., Schäfer, I., & TRAUMAB Study Group (2018). Differential relationships of PTSD and childhood trauma with the course of substance use disorders. Journal of Substance Miller, E. A., Green, A. E., Fettes, D. L., & Aarons, G. A. (2011). Prevalence of maltreatment among youths in public sectors of care. Child Maltreatment, 16, 196-204. Monson, C. M., Schnurr, P. P., Resick, P. A., Friedman, M. J., Young-Xu, Y., & Stevens, S. P. (2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Moore, E., Gaskin, C., & Indig, D. (2013). Childhood maltreatment and post-traumatic stress disorder among incarcerated young offenders. Child Abuse Najavits, L. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. Guilford Publications. Porche, M., Fortuna, L., Lin, J., & Alegria, M. (2011). Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young Five forms of childhood trauma: Relationships with employment in adulthood. Child Abuse & Neglect, 36(9), 676-679. https://doi.org/10.4088/PCC.12m01353 Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (1st ed.). New York: NY: Guilford. Substance Abuse and Mental Health Services Administration. (2014a) SAMHSA’s Concept of Trauma 26 PERSPECTIVESVOLUME 46, NUMBER 3 INFORMATION PROCESSING MATTERS and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Substance Abuse and Mental Health Services Administration. (2014b). Trauma-informed care in behavioral health services. Treatment Improvement Protocol (TIP) Series 57 [HHS Publication No. SMA 13-4801]. Rockville, MD: Substance Abuse and Mental Substance Abuse and Mental Health Services Administration. (2019). Enhancing motivation to change in substance use disorder treatment. Treatment Improvement Protocol (TIP) Series 35 [HHS Publication No. EP19-02-01-003]. Rockville, MD: Substance Abuse Tam, T. W., Zlotnick, C., & Robertson, M. J. (2003). Longitudinal perspective: Adverse childhood events, substance use, and labor force participation among homeless adults. The American Journal of Drug and Vitopoulos, N. A., Peterson-Badali, M., Brown, S., & Skilling, T. A. (2018). The Relationship Between Trauma, Recidivism Risk, and Reoffending in Male and Female Juvenile Offenders. Journal of child & adolescent trauma, Ward, T. Melser, J., & Yates, P. M. (2007). Reconstructing the risk-need-responsivity model: A theoretical elaboration and evaluation. Aggression and Violent Wilson, H. W., Berent, E., Donenberg, G. R., Emerson, E. M., Rodriguez, E. M., & Sandesara, A. (2013). Trauma History and PTSD Symptoms in Juvenile Offenders on Probation. Victims & offenders, 8(4), Wolff, N., Shi, J., Blitz, C. L., & Siegel, J. (2007). Understanding sexual victimization inside prisons: Factors that predict risk. Criminology & Public Yoon, D. (2020). Peer-relationship patterns and their association with types of child abuse and adolescent risk behaviors among youth at-risk of maltreatment. Journal Zielinski, D. S. (2009). Child maltreatment and adult socioeconomic well-being. Child Abuse & Author Bio: Kimberly Gentry, Ph.D. Talbert House Center for Health and Human Services Research 2600 Victory Parkway Cincinnati, OH 45206 513-751-7747 27 AMERICAN PROBATION AND PAROLE ASSOCIATION INFORMATION PROCESSING MATTERS Columbus New Orleans Omaha Philadelphia Los Angeles - 01/23 – 01/25 - 01/29 – 01/31 - 02/05 – 02/07 - 02/12 – 02/14 - 02/26 – 02/28 Connect with friends and colleagues as APPA, the national professional membership organization for probation and parole officers, hosts its first ever five regional training events with five programs at each location of presenters, engaging sessions, and an exhibit area. Experience valuable training at substantial savings due to reduced travel expenses. APPA’s 2023 Winter Regional Training Institutes are your opportunity to hone in on your personal development. This is your chance to explore the future of probation and parole technologies and where our industry is headed, discover best practices and strategies to enhance your everyday work, and leave more inspired and take focused ideas and information back to your office and co-workers!28 PERSPECTIVESVOLUME 46, NUMBER 3 INFORMATION PROCESSING MATTERS People on community supervision with serious mental illness (SMI), such as major depression, bipolar disorder, and schizophrenia, have higher re-arrest rates than those without and are more likely to have probation revoked (Brooker et al., 2020; Skeem et al., 2006), often because of new convictions for minor crimes or failure to comply with probation (e.g., inability to pay fines, adhere to schedules, or gain employment). Probationers with SMI present with significant case management challenges, such as clinical treatment noncompliance, stigma and discrimination, housing insecurity, financial constraints, and vocational challenges. These concerns complicate efforts to access already difficult-to-obtain community- based mental health care (National Alliance on Mental Illness, 2017). Traditional probation approaches such as enforcement, monitoring, and sanctions were not designed to address complex psychosocial needs (Brooker et al., 2020; Eno Louden et al., 2008). Historically, policy responses to reduce the prevalence of SMI in the criminal justice system emphasized connections to mental health services (Skeem et al., 2011). Treating SMI improves health outcomes and reduces health disparities (Brooker et al., 2020). However, most people with SMI do not recidivate as a direct result of uncontrolled psychiatric symptoms, but rather because of traditional criminogenic risk factors, such as antisocial thinking, associates, and behavior (Bonta & Andrews, 2016; Bonta et al., 2014; Bonta et al., 1998; Junginger et al., 2006; Peterson et al., 2010). The link between SMI and criminal justice system involvement is typically indirect, making the provision of clinical treatment alone an insufficient response to improve criminal justice outcomes (Bonta et al., 1998; Callahan & Silver, 1998; Epperson et al., 2014; Skeem et al., 2011). The leading model for recidivism reduction, the Risk- Need-Responsivity Model (Bonta & Andrews, 2016), views neurocognitive and social impairments associated with SMI as a specific responsivity factor impacting one’s ability to engage in interventions that target criminogenic needs (e.g., substance use, antisocial thinking; Skeem et al., 2014). For probationers with SMI, mental health treatment should be paired with correctional interventions that use cognitive behavioral therapy and social learning techniques to mitigate criminal risk factors. Few programs address SMI and criminal risk factors simultaneously Simera & Bonfine: MENTAL ILLNESS AS A RESPONSIVITY FACTOR IN THE RISK, NEEDS, AND RESPONSIVITY FRAMEWORK 29 AMERICAN PROBATION AND PAROLE ASSOCIATION INFORMATION PROCESSING MATTERS (Morgan et al., 2018), although emerging evidence suggests such programs improve symptoms and reduce aspects of antisocial thinking (Gaspar et al., 2019). Understanding how to optimally adapt the delivery of correctional interventions to improve their effectiveness for probationers with SMI is an emerging area of interest in program and policy development (Wilson et al. 2018). Recommendations to Support Probationers with Mental Illness To meet the needs of probationers with SMI, we recommend the following: Use evidence-based screening and assessment tools to identify mental health and/or substance use treatment needs and criminogenic risk factors. A comprehensive assessment can identify probationers’ clinical and social service needs and guide treatment plan development (Substance Abuse and Mental Health Services Administration, 2015). Implement specialty probation. Features of specialty probation include exclusive mental health caseloads, smaller caseloads (e.g., caseloads of 30 to 50 people, compared to general population caseloads of >100 probationers), ongoing officer training and supervision in mental health supervision, integration of resources to meet probationers’ needs, and an individualized, problem-solving approach to address treatment noncompliance (Manchak et al., 2014; Skeem et al., 2006; Skeem et al., 2017). Specialty probation officers take on both a legal/surveillance role and a therapeutic approach. Smaller caseloads ensure sufficient time to build caring, trusting staff-client relationships and engage in case coordination. Successful implementation requires collaborative relationships between probation and behavioral health service providers to align clinical services with probation. Research suggests specialty probation is more effective than traditional probation for improving mental health (e.g., treatment engagement, well-being) and criminal justice outcomes (e.g., decreased likelihood of probation violations, reduced arrests, successful completion of community supervision) (Skeem et al., 2017; Wolff et al., 2014). Create partnerships between probation and behavioral health providers. Probation officers are well positioned to be boundary spanners between criminal justice and other services (Skeem et al., 2006), enacting collaborative strategies such as information sharing agreements between participating organizations and helping remove barriers to treatment access. Boundary spanning between probation and behavioral health uses positive probation practices, such as problem solving, to promote service coordination, improve treatment involvement, and expand surveillance through joint monitoring (Manchak et al., 2014; Schwalbe & Maschi, 2012). To build effective cross-systems partnerships, consider holding regularly scheduled team meetings or check-ins with probation officers and behavioral health providers. Provide cross-systems training sessions. Cross- systems training will ensure that probation officers with assigned caseloads of individuals with SMI have a greater understanding of mental illnesses, possess greater knowledge about local systems of care, and can effectively communicate with and advocate on behalf of their supervisees, thereby potentially improving relationships between probationers and officers (Manchak et al., 2014). Equally important is creating opportunities for cross-systems training for mental health professionals about principles and techniques of probation, criminal risk factors, and criminal justice system processes and policies. Implementing the above recommendations may take some planning and motivation but is definitely achievable. For example, the Crisis Prevention and Intervention Outreach Team of the Adult Probation Department in Lorain County, Ohio, can be considered an exemplar of a program that incorporates cross-systems training and emphasizes collaborative partnerships. In this program, officers learn signs and symptoms of mental illness and well as de-escalation techniques, and they make connections with the mental health treatment system. Probation officers learn how to take a problem- prevention and problem-solving approach in collaboration with their probationers, the mental health system, and law enforcement officers. While program evaluation is needed, promising strategies from this program include home and wellness visits during non-crisis periods and the offering of incentives (e.g., gas or food cards) for participation in mental health services. The program features policies co-designed with community partners, such as contacting probationers prior to visits and having three probation officers present, with at least two of these officers having completed the Crisis Intervention Team patrol officer training course. Next >