The Criminal Justice Outcomes of Jail Diversion Programs for Persons With Mental Illness: A Review of the Evidence

Article Figures & Data

Table 1

Levels of Evidence for Treatment Efficacy

1a	Systematic review of random controlled trials (RCTs)
1b	Individual RCT with narrow confidence interval
1c	All or none
2a	Systematic review of cohort studies
2b	Individual cohort study (including low quality RCT; e.g., <80% follow-up)^*
2c	“Outcomes” research; ecological studies
3a	Systematic review of case-control studies
3b	Individual case-control study
4	Case-series (and poor-quality cohort and case-control studies^†)
5	Expert opinion without explicit critical appraisal, or based on physiology, bench research, or first principles

Adapted from the Oxford Centre for Evidence-Based Medicine.³²
* Quasi-experimental design (i.e. non-equivalent comparison group studies) match cohort studies and therefore meet level 2b evidence.³³
† Poor-quality cohort study refers to cohort studies that did not clearly define comparison groups and/or did not measure exposures and outcomes in the same way in both exposed and nonexposed individuals, did not identify or appropriately control known confounders, and failed to carry out a sufficiently long and complete follow-up of patients.

Table 2

Jail Diversion Programs

Investigators	No. of Groups, Diversion Type (Total Sample Size for All Groups)	Research Design	Follow-up Months	Rearrest Prevalence	Rearrest Incidence	Jail Time for Index Offense
Prebooking diversion
Gratton et al.³⁹	1 PBD (55); 1 TAU (116)	QED	12	NR	0	NR
Steadman et al.⁴⁰	3 PBD (300)	Retrospective Cohort	0	NR	NR	+
Jail-based diversion
Shafer et al.⁴¹; Lattimore et al.¹	2 JBD (124); 2 TAU (78)	QED	12	0	0	NR
Court-based diversion
Steadman et al.⁴²	1 CBD (35); TAU (45)	QED	2	0	NR	+
Hoff et al.³⁷	1 CBD (314); 1 TAU (124)	Retrospective Cohort	12	NR	NR	+
Rowe et al.⁴⁴	1 CBD +PS^* (73); 1 CBD (41)	RCT	12	NR	0	NR
Frisman et al.⁴⁵	7 CBD (113); 5 TAU (98)	QED	12	0	NR	+
McNiel and Binder⁴⁶	1 MHC (170); 1 TAU (8067)	Retrospective cohort	At least 6	+	NR	NR
Trupin et al.⁴⁷; Trupin and Richards⁴⁸	2 MHC (96); 2 TAU (128)	QED	At least 9	−	0	0
Moore and Hiday⁴⁹	1 MHC (82); 1 TAU (183)	Retrospective cohort	12	0	+	NR
Moore⁵⁰
Christy et al.⁵¹	1 MHC (116); 1 TAU (101)	QED matched pairs	12	0	0	+
Cosden et al.^52–54	1 MHC+ACT^† (137); 1 TAU (98)	RCT	24	NR	−	0
Neiswender⁵⁵	1 MHC (114); 1 TAU (80)	Retrospective cohort	24	NR	NR	+
Cross-model and pooled comparisons
Broner et al.⁵⁶	1 JBD (77); 1 CBD (35); 1 TAU (119)	QED	12	NR	0	+
Broner et al.⁵⁷; Lattimore et al.¹	3 PBD; 3 JBD; 1 CBD; 1 MHC; 8 TAU (NR)	QED	12	NR	0	+
Steadman and Naples⁵⁸	3 PBD+1 JBD+2 CBD+1 MHC+6 TAU = (1185)	QED	12	NR	0	NR
Aos et al.²⁶	3 PBD+3 JBD+2 CBD+3 MHC = (1243) 11 TAU (NR)	Meta-analysis	12–24	NR	0	NR

+, Statistically significant difference in criminal justice outcome was reported in favor of a treatment intervention relative to control/comparison condition; 0, no statistically significant difference between treatment and comparison/control conditions; −, statistically significant difference in criminal justice outcome in favor of the control/comparison condition relative to the intervention condition; NR, not reported.
* PS, peer support program.
† ACT, assertive community treatment program.