March 25, 2019 | Announcements | SAMHSA's GAINS Center Matthew W. Epperson, PhD, MSW; Associate Professor, University of Chicago School of Social Service Administration; Director, Smart Decarceration Project (hyperlink: www.smartdecarceration.org); Twitter: @sdpUChicago Probation serves the largest segment of the criminal justice-involved population. Despite diversion efforts that target early criminal justice (CJ) intercept points—aiming to direct people to appropriate mental health services instead of justice involvement—an estimated half-million of the nearly 4 million individuals on probation have serious mental illnesses (SMI).[1, 2] People on probation with SMI face many complex challenges, including increased rates of probation failure, which places them at risk of further involvement in the CJ system via incarceration.[3-6] Despite this great need, there is a dearth of research that has enhanced the capacity of probation to meet the particular needs of people with SMI.[7, 8] Oftentimes in probation settings, considerable emphasis is placed on monitoring compliance and addressing assessed criminogenic needs, usually at the expense of responding to a range of concerns that individuals on probation with SMI present. For the past 8 years I have studied probation programs, largely by exploring the experiences of people on probation with SMI and probation officers. Through hundreds of interviews and observations, one critical topic that continually resurfaces is the need for a therapeutic relationship between probation officer and client. In a study of individuals on probation with SMI involved in standard probation, specialized mental health probation, and mental health court, participants expressed that relational features of caring, support, and trust were critical elements impacting their ability to actively participate in probation and, more importantly, to engage with needed community-based mental health services. Probation officers who work with individuals on probation with SMI also discuss relationship-building strategies as a core component of their work, but the relationship is often strained by the multiple roles that probation officers must serve. Specific to their work with this population, officers discuss having to walk a line between social work and law enforcement roles, particularly because they are often tasked with linking their clients to appropriate services in the community while also having to facilitate drug tests and deliver sanctions for non-compliance.  Therapeutic relationship-building in the context of probation supervision is more than an ethical and humane approach – it is effective practice. Studies examining the effectiveness of specialized programming for justice-involved people with SMI consistently agree that sole reliance on surveillance and punishment is ineffective at improving mental health and preventing further CJ involvement. Several empirical studies of individuals on probation with SMI have shown that a higher-quality relationship is associated with higher probation completion rates, increased engagement in services, and reduced recidivism post-probation. [1, 9, 12] Moreover, successful engagement of individuals on probation with SMI is related to an increased sense of procedural justice (or fairness) and lower perceptions of coercion, both of which are indicators of higher participation in treatment and CJ programming.[13-15] While these studies demonstrate that the quality of the relationship between officer and client is a critical ingredient in achieving better mental health and CJ outcomes, no effective interventions have been developed to target this relationship among individuals on probation with SMI. To address this need, I have engaged in a long-term collaboration with the Adult Probation Department in Cook County, Illinois, to develop an intervention for probation officers that targets building a therapeutic relationship in order to promote service engagement. The process began with a series of intensive meetings with a stakeholder panel consisting of probation staff, former people on probation with SMI, community mental health treatment providers, and advocates. Additionally, we observed dozens of meetings between probation officers and people on probation with SMI to better understand the context in which the intervention would be delivered. This formative work led to the identification of two key intervention components that are hypothesized to influence the working relationship: engagement and shared decision-making. Engagement activities are focused on the first probation sessions and include discussion of previous probation experiences, acknowledgement of power differentials, clarification of probation expectations and roles, and an exploration of probationer goals. The intervention also helps probation officers to identify and utilize opportunities for individuals on probation with SMI to collaboratively make treatment-related and other key decisions, with the goal of creating an environment in which they feel empowered to express their preferences. This work reflects a well-established clinical understanding that has been validated by research in a range of human services delivery settings: The quality of the therapeutic relationship is equally as predictive of desired outcomes as the evidence-based practice being delivered. In the context of probation for people with SMI, the foundation of a therapeutic relationship must be built before case management, treatment linkage, and criminogenic risk reduction interventions can achieve optimal impact. This approach also elevates the importance of therapeutic and rehabilitative aims within CJ settings that are often overly punitive and coercive. It is my hope that interventions like this will not only help CJ professionals more humanely engage with people with SMI, but also help to lessen their entanglement in the CJ system. Skeem, J., P. Emke-Francis, and Eno Louden, J. (2006). Probation, mental health, and mandated treatment: a national survey. Criminal Justice and Behavior, 33(2), p. 158-184. Glaze, L.E., and Parks, E. (2012). Correctional populations in the United States, in Bureau of Justice Statistics Bulletin. U.S. Department of Justice, Office of Justice Programs. Cloyes, K.G., et al. (2010). Time to prison return for offenders with serious mental illness released from prison: A survival analysis. Criminal Justice and Behavior, 37(2), p. 175-187. Ostermann, M., and Matejkowski, J. (2012). Exploring the intersection of mental health and release status with recidivism. Justice Quarterly. Skeem, J.L., Emke-Francis, P., and Louden, J.E. (2006). Probation, mental health, and mandated treatment: a national survey. Criminal Justice and Behavior, 33(2), p. 158-184. Baillargeon, J., et al. (2009). Parole revocation among prison inmates with psychiatric and substance use disorders. Psychiatric Services, 60(11), p. 1516-1521. Epperson, M., et al. (2014). Envisioning the next generation of behavioral health and criminal justice interventions. International journal of law and psychiatry, 37(5), p. 427-438. Wolff, N., et al. (2013). Practice informs the next generation of behavioral health and criminal justice interventions. International Journal of Law and Psychiatry, 36, p. 1-10. Epperson, M., et al. (2017). Unpacking the relationship between probatinoers with serious mental illnesses and probation staff. Journal of Offender Rehabilitation, 56(3), p. 188-216. Epperson, M., et al. (2014). Walking the line: Specialized and standard probation officer perspectives on supervising probationers with serious mental illnesses. International Journal of Law & Psychiatry, 37, p. 473-483. Lamberti, J. (2016). Preventing criminal recidivism through mental health and criminal justice collaboration. Psychiatric Services, 67(11), p. 1206-1212. Kennealy, P., et al. (2012). Firm, Fair, and Caring Officer-Offender Relationships Protect Against Supervision Failure. Law and Human Behavior, 36(6), p. 496–505. Canada, K. and Watson, A. (2013). “Cause everybody likes to be treated good:” Perceptions of procedural justice among mental health court participants. American Behavioral Scientist, 57(2), p. 209-230. Watson, A., and Angell, B. (2007). Applying procedural justice theory to law enforcement’s response to persons with mental illness. Psychiatric Services, 58(6), p. 787-793. Blasko, B. and Taxman, F. (2018). Are supervision practices procedurally fair? Development and predictive utility of a procedural justice measure for use in community corrections settings. Criminal Justice and Behavior, 45(3), p. 402-420.