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OtherREGULAR ARTICLE

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

Frank Sirotich
Journal of the American Academy of Psychiatry and the Law Online December 2009, 37 (4) 461-472;
Frank Sirotich
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    Table 1

    Levels of Evidence for Treatment Efficacy

    1aSystematic review of random controlled trials (RCTs)
    1bIndividual RCT with narrow confidence interval
    1cAll or none
    2aSystematic review of cohort studies
    2bIndividual cohort study (including low quality RCT; e.g., <80% follow-up)*
    2c“Outcomes” research; ecological studies
    3aSystematic review of case-control studies
    3bIndividual case-control study
    4Case-series (and poor-quality cohort and case-control studies†)
    5Expert 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.

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    Table 2

    Jail Diversion Programs

    InvestigatorsNo. of Groups, Diversion Type (Total Sample Size for All Groups)Research DesignFollow-up MonthsRearrest PrevalenceRearrest IncidenceJail Time for Index Offense
    Prebooking diversion
        Gratton et al.391 PBD (55); 1 TAU (116)QED12NR0NR
        Steadman et al.403 PBD (300)Retrospective Cohort0NRNR+
    Jail-based diversion
        Shafer et al.41; Lattimore et al.12 JBD (124); 2 TAU (78)QED1200NR
    Court-based diversion
        Steadman et al.421 CBD (35); TAU (45)QED20NR+
        Hoff et al.371 CBD (314); 1 TAU (124)Retrospective Cohort12NRNR+
        Rowe et al.441 CBD +PS* (73); 1 CBD (41)RCT12NR0NR
        Frisman et al.457 CBD (113); 5 TAU (98)QED120NR+
        McNiel and Binder461 MHC (170); 1 TAU (8067)Retrospective cohortAt least 6+NRNR
        Trupin et al.47; Trupin and Richards482 MHC (96); 2 TAU (128)QEDAt least 9−00
        Moore and Hiday491 MHC (82); 1 TAU (183)Retrospective cohort120+NR
        Moore50
        Christy et al.511 MHC (116); 1 TAU (101)QED matched pairs1200+
        Cosden et al.52–541 MHC+ACT† (137); 1 TAU (98)RCT24NR−0
        Neiswender551 MHC (114); 1 TAU (80)Retrospective cohort24NRNR+
    Cross-model and pooled comparisons
        Broner et al.561 JBD (77); 1 CBD (35); 1 TAU (119)QED12NR0+
        Broner et al.57; Lattimore et al.13 PBD; 3 JBD; 1 CBD; 1 MHC; 8 TAU (NR)QED12NR0+
        Steadman and Naples583 PBD+1 JBD+2 CBD+1 MHC+6 TAU = (1185)QED12NR0NR
        Aos et al.263 PBD+3 JBD+2 CBD+3 MHC = (1243) 11 TAU (NR)Meta-analysis12–24NR0NR
    • +, 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.

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Journal of the American Academy of Psychiatry and the Law Online: 37 (4)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 37, Issue 4
December 2009
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The Criminal Justice Outcomes of Jail Diversion Programs for Persons With Mental Illness: A Review of the Evidence
Frank Sirotich
Journal of the American Academy of Psychiatry and the Law Online Dec 2009, 37 (4) 461-472;

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