Current research projects
We are excited to share the research we are up to for the 2022/23 academic year!
Alabama Forensic Assessment Research and Evaluation Project (Alabama FARE)
Investigators: Kois & Cox
Funding source: Alabama Department of Mental Health, $215k annually, ongoing renewal
Across the country, forensic mental health systems are overwhelmed by the number of pre-trial accused in need of evaluation and treatment. These backlogs ("forensic waitlists") lead to lawsuits alleging violations of accused's constitutional right to due process (e.g., Bicha v. Hale, Hunter v. Beshear). The Alabama Forensic Assessment Research and Evaluation Project (Alabama FARE) is a collaboration between the Alabama Department of Mental Health and Drs. Kois and Cox to address the state's forensic waitlists via innovative and evidence-based best practices and evaluate the effectiveness of these practices. FARE researchers will assist ADMH in the design, implementation, and integrity of clinical forensic assessment and intervention programs at ADMH’s Bryce Hospital, Taylor Hardin Secure Medical Facility, and related programs in the Tuscaloosa and Birmingham areas. FARE funds clinical and research services that will engage undergraduate, post-baccalaureate, and doctoral trainees.
Building financial empowerment to reduce recidivism: An effectiveness-implementation trial of a money management intervention for justice-involved individuals with serious mental illness ($AFE)
Investigators: Kois (PI), Elbogen (Co-PI), & Cox (Co-PI); Consultant: Wolff
Funding source: Justice and Mental Health Collaboration Program, Office of Justice Programs, Department of Justice, $431k over three years
Justice-involved people with serious mental illness (SMI) face substantial barriers to personal and financial wellbeing. They are at high risk for financial destabilizers, including delayed social security benefit re-instatement upon re-entering the community, difficulty securing and maintaining employment, and homelessness. Financial debt is highly common among offenders, particularly those with SMI, and shares a complex relationship with crime: debt is a risk factor for crime, and crime is a risk factor for debt. Yet no interventions have assessed how financial empowerment may impact recidivism among this at-risk population. In Alabama, such a program is direly needed. The state ranks 7th in the nation for both the highest crime and highest poverty rates, and relative to most of the country, it allocates fewer resources to mental health services. In response to this solicitation, FARE will join with mental health and criminal justice agencies in Alabama, including Indian Rivers Behavioral Health and the Jefferson, Tuscaloosa, and Shelby County Mental Health Courts to achieve three objectives: 1) Develop a financial empowerment program for justice-involved individuals with SMI informed by Risk-Need-Responsivity principles and research on SMI, financial instability, and crime, with the aim of reducing recidivism; 2) Provide programmatic support to execute the program; and 3) Provide capacity building to sustain the program. This ambitious project will produce many meaningful deliverables, but several warrant special mention. JMHCP's return on investment will include: Findings from a 150-participant randomized controlled trial of the $teps for Achieving Financial Empowerment ($AFE) program, with recidivism as primary outcome; a revised $AFE program, informed by comprehensive quantitative and qualitative data, that will be disseminated to mental health and criminal justice stakeholders at project completion; distribution of policy papers; training of mental health and criminal justice agency staff in $AFE protocol via in-person and webinar formats; and the establishment of a $AFE volunteer facilitator program.
Competency restoration with REACH: Implementing in-person and videoconference technology restoration protocols within Alabama's under-resourced and rural juails
Investigators: Kois (PI), Batastini (Co-PI); Cox (I), Scott Adams (I)
Funding source: Justice and Mental Health Collaboration Program, Office of Justice Programs, Department of Justice, $534k over three years
To strategically address Alabama’s “competency crisis” at the system-level and develop a much-needed spectrum of competency restoration (CR) programming, our objectives are to (1) Develop, monitor, and evaluate a cross-system CR collaboration across mental health agencies, courts, and jails in Alabama; (2) Operate the jail-based CR program REACH within the Jefferson County (Birmingham location) jail; (3) Expand REACH to under resourced rural jails in Alabama via videoconference technology, and (4) Disseminate REACH to academic, practice, and policy stakeholders and plan for sustainability, scale up, and spread.
Cognitive Behavioral Therapy for Psychosis for competency restoration
Investigators: Kois, *Hunter, Young, Caro, Jenkins, Brown, Bolinger, & Kinlen.
CLASS and the Washington state Office of Forensic Mental Health Services (OFMHS) has worked to develop a novel, evidence-informed intervention for serving individuals with delusional beliefs who are undergoing competence restoration. For the 2022 meeting of the American Psychology-Law Society, we presented:: 1) How the collaboration fostered and identified research priorities; 2) Findings of a staff needs assessment and implementation survey, specific to the Cognitive Behavioral Therapy for Psychosis (CBTp) intervention Michael’s Game; and 3) Development of a novel CBTp for restoration intervention, originally titled Stephen’s Game. We are excited to continue developing Stephen's Game throughout 2022.
ALL OF THE META-ANALYSES!
Investigators: Kois, *White, *Stewart, *McDowell, Gowensmith, Murrie, Packer
Our team is conducting three meta-analyses: correlates of incompetency (first and subsequent evaluations), correlates of restoration and restoration's effectiveness, and correlates of conditional release outcomes. This has been a huge undertaking and the graduate research assistants (White, Stewart, and McDowell) are killing it with all of the many steps that go into conducting meta-analyses.
Contemporary competence to proceed metrics reported by U.S. judiciaries
Investigators: Kois, *Potts, *Cappello, Cox, & Zapf
Competence to proceed (CTP) evaluations have profound consequences at the individual and jurisdictional level. The criminal legal system is in the midst of an “incompetency crisis” with the number of accused referred for CTP evaluations far outpacing governmental resources to evaluate and treat these individuals. Many jurisdictions are so overwhelmed with CTP referrals that accused are waiting over 12 months for an initial evaluation. During this waiting period, many accused remain incarcerated in local jails. These backlogs lead to lawsuits alleging violations of accused's constitutional right to due process (e.g., Bicha v. Hale, Hunter v. Beshear). Before practitioners, researchers, and policymakers jump to address these problems, basic, descriptive information on the CTP process is needed to make informed decisions. However, CTP evaluation frequency and related metrics have not been systematically estimated at the national level since Poythress and colleagues’ 2002 descriptive review, which suggested that 60,000 evaluations take place annually. To update this figure, we have requested CTP data directly from nationwide judiciaries. Preliminary results suggest that the annual number of CTP evaluations likely doubles the Poythress estimate, with individual jurisdictions reporting upwards of 9,000 annually. This suggests that the "crisis" may be more severe than previously realized and that the practitioner community, legal professionals, and policy makers may consider broadening the scope of how they address this problem.
Overdue perspectives: Adopting patient-centered outcomes in competency restoration research
Investigators: Kois, Cox, *Hunter, *Potts, *White, & *Stewart
Patient-centered outcomes research is common in healthcare settings and is associated with increased patient engagement and treatment success. In this approach, researchers consider patients as experts and value them as equal project partners, rather than research participants. Unfortunately, this framework is rarely used when researching severe mental illness and is practically unheard of in forensic mental health settings. We are conducting the first known patient-centered outcomes study of individuals undergoing inpatient competency restoration (CR). This study fosters inclusivity and respect for accused and inpatient experiences, and findings provide important directions for enhancing CR programming using a person-centered, recovery-oriented approach.
Attorney justification for competency to proceed evaluation referrals
Investigators: Kois, Cox, *Hunter, *Doran, *Hayes, *Giannetta, *Potts, & *White
Defense counsel is the most common referral source for competency to proceed (CTP) evaluations, yet there is little data regarding why attorneys refer accused and what information they communicate to evaluators. Using thematic content analysis, researchers reviewed 78 CTP referral forms and analyzed attorneys’ verbatim rationale for requesting evaluations. Emerging themes, in order of prevalence, included: accused's current mental health presentation, historical mental health diagnoses and prior CTP, and current psycholegal deficits. However, attorneys generally provided little information. Findings suggested that many attorneys may equate current or past mental illness with incompetency which have referral process and attorney education implications.
* denotes student author
Alabama Forensic Assessment Research and Evaluation Project (Alabama FARE)
Investigators: Kois & Cox
Funding source: Alabama Department of Mental Health, $215k annually, ongoing renewal
Across the country, forensic mental health systems are overwhelmed by the number of pre-trial accused in need of evaluation and treatment. These backlogs ("forensic waitlists") lead to lawsuits alleging violations of accused's constitutional right to due process (e.g., Bicha v. Hale, Hunter v. Beshear). The Alabama Forensic Assessment Research and Evaluation Project (Alabama FARE) is a collaboration between the Alabama Department of Mental Health and Drs. Kois and Cox to address the state's forensic waitlists via innovative and evidence-based best practices and evaluate the effectiveness of these practices. FARE researchers will assist ADMH in the design, implementation, and integrity of clinical forensic assessment and intervention programs at ADMH’s Bryce Hospital, Taylor Hardin Secure Medical Facility, and related programs in the Tuscaloosa and Birmingham areas. FARE funds clinical and research services that will engage undergraduate, post-baccalaureate, and doctoral trainees.
Building financial empowerment to reduce recidivism: An effectiveness-implementation trial of a money management intervention for justice-involved individuals with serious mental illness ($AFE)
Investigators: Kois (PI), Elbogen (Co-PI), & Cox (Co-PI); Consultant: Wolff
Funding source: Justice and Mental Health Collaboration Program, Office of Justice Programs, Department of Justice, $431k over three years
Justice-involved people with serious mental illness (SMI) face substantial barriers to personal and financial wellbeing. They are at high risk for financial destabilizers, including delayed social security benefit re-instatement upon re-entering the community, difficulty securing and maintaining employment, and homelessness. Financial debt is highly common among offenders, particularly those with SMI, and shares a complex relationship with crime: debt is a risk factor for crime, and crime is a risk factor for debt. Yet no interventions have assessed how financial empowerment may impact recidivism among this at-risk population. In Alabama, such a program is direly needed. The state ranks 7th in the nation for both the highest crime and highest poverty rates, and relative to most of the country, it allocates fewer resources to mental health services. In response to this solicitation, FARE will join with mental health and criminal justice agencies in Alabama, including Indian Rivers Behavioral Health and the Jefferson, Tuscaloosa, and Shelby County Mental Health Courts to achieve three objectives: 1) Develop a financial empowerment program for justice-involved individuals with SMI informed by Risk-Need-Responsivity principles and research on SMI, financial instability, and crime, with the aim of reducing recidivism; 2) Provide programmatic support to execute the program; and 3) Provide capacity building to sustain the program. This ambitious project will produce many meaningful deliverables, but several warrant special mention. JMHCP's return on investment will include: Findings from a 150-participant randomized controlled trial of the $teps for Achieving Financial Empowerment ($AFE) program, with recidivism as primary outcome; a revised $AFE program, informed by comprehensive quantitative and qualitative data, that will be disseminated to mental health and criminal justice stakeholders at project completion; distribution of policy papers; training of mental health and criminal justice agency staff in $AFE protocol via in-person and webinar formats; and the establishment of a $AFE volunteer facilitator program.
Competency restoration with REACH: Implementing in-person and videoconference technology restoration protocols within Alabama's under-resourced and rural juails
Investigators: Kois (PI), Batastini (Co-PI); Cox (I), Scott Adams (I)
Funding source: Justice and Mental Health Collaboration Program, Office of Justice Programs, Department of Justice, $534k over three years
To strategically address Alabama’s “competency crisis” at the system-level and develop a much-needed spectrum of competency restoration (CR) programming, our objectives are to (1) Develop, monitor, and evaluate a cross-system CR collaboration across mental health agencies, courts, and jails in Alabama; (2) Operate the jail-based CR program REACH within the Jefferson County (Birmingham location) jail; (3) Expand REACH to under resourced rural jails in Alabama via videoconference technology, and (4) Disseminate REACH to academic, practice, and policy stakeholders and plan for sustainability, scale up, and spread.
Cognitive Behavioral Therapy for Psychosis for competency restoration
Investigators: Kois, *Hunter, Young, Caro, Jenkins, Brown, Bolinger, & Kinlen.
CLASS and the Washington state Office of Forensic Mental Health Services (OFMHS) has worked to develop a novel, evidence-informed intervention for serving individuals with delusional beliefs who are undergoing competence restoration. For the 2022 meeting of the American Psychology-Law Society, we presented:: 1) How the collaboration fostered and identified research priorities; 2) Findings of a staff needs assessment and implementation survey, specific to the Cognitive Behavioral Therapy for Psychosis (CBTp) intervention Michael’s Game; and 3) Development of a novel CBTp for restoration intervention, originally titled Stephen’s Game. We are excited to continue developing Stephen's Game throughout 2022.
ALL OF THE META-ANALYSES!
Investigators: Kois, *White, *Stewart, *McDowell, Gowensmith, Murrie, Packer
Our team is conducting three meta-analyses: correlates of incompetency (first and subsequent evaluations), correlates of restoration and restoration's effectiveness, and correlates of conditional release outcomes. This has been a huge undertaking and the graduate research assistants (White, Stewart, and McDowell) are killing it with all of the many steps that go into conducting meta-analyses.
Contemporary competence to proceed metrics reported by U.S. judiciaries
Investigators: Kois, *Potts, *Cappello, Cox, & Zapf
Competence to proceed (CTP) evaluations have profound consequences at the individual and jurisdictional level. The criminal legal system is in the midst of an “incompetency crisis” with the number of accused referred for CTP evaluations far outpacing governmental resources to evaluate and treat these individuals. Many jurisdictions are so overwhelmed with CTP referrals that accused are waiting over 12 months for an initial evaluation. During this waiting period, many accused remain incarcerated in local jails. These backlogs lead to lawsuits alleging violations of accused's constitutional right to due process (e.g., Bicha v. Hale, Hunter v. Beshear). Before practitioners, researchers, and policymakers jump to address these problems, basic, descriptive information on the CTP process is needed to make informed decisions. However, CTP evaluation frequency and related metrics have not been systematically estimated at the national level since Poythress and colleagues’ 2002 descriptive review, which suggested that 60,000 evaluations take place annually. To update this figure, we have requested CTP data directly from nationwide judiciaries. Preliminary results suggest that the annual number of CTP evaluations likely doubles the Poythress estimate, with individual jurisdictions reporting upwards of 9,000 annually. This suggests that the "crisis" may be more severe than previously realized and that the practitioner community, legal professionals, and policy makers may consider broadening the scope of how they address this problem.
Overdue perspectives: Adopting patient-centered outcomes in competency restoration research
Investigators: Kois, Cox, *Hunter, *Potts, *White, & *Stewart
Patient-centered outcomes research is common in healthcare settings and is associated with increased patient engagement and treatment success. In this approach, researchers consider patients as experts and value them as equal project partners, rather than research participants. Unfortunately, this framework is rarely used when researching severe mental illness and is practically unheard of in forensic mental health settings. We are conducting the first known patient-centered outcomes study of individuals undergoing inpatient competency restoration (CR). This study fosters inclusivity and respect for accused and inpatient experiences, and findings provide important directions for enhancing CR programming using a person-centered, recovery-oriented approach.
Attorney justification for competency to proceed evaluation referrals
Investigators: Kois, Cox, *Hunter, *Doran, *Hayes, *Giannetta, *Potts, & *White
Defense counsel is the most common referral source for competency to proceed (CTP) evaluations, yet there is little data regarding why attorneys refer accused and what information they communicate to evaluators. Using thematic content analysis, researchers reviewed 78 CTP referral forms and analyzed attorneys’ verbatim rationale for requesting evaluations. Emerging themes, in order of prevalence, included: accused's current mental health presentation, historical mental health diagnoses and prior CTP, and current psycholegal deficits. However, attorneys generally provided little information. Findings suggested that many attorneys may equate current or past mental illness with incompetency which have referral process and attorney education implications.
* denotes student author
