Jail recidivists with serious mental illness and substance use disorders were treated in an in-custody setting and then randomly assigned to either a high fidelity Integrated Dual Disorders Treatment program (103 participants) or to service as usual (79 participants). Outcomes were tracked an average of 18 months from program entry at the termination of the initial incarceration. A reduction in jail days from baseline to study period was significant for both groups. The pre to post reduction for arrests and total convictions was significant in the experimental group but not the control group. However, during the study period, differences between experimental and control groups in arrests, convictions and jail days were not statistically significant. Experimental participants had lower study period psychiatric inpatient and crisis utilization and greater outpatient utilization than did control group participants. The groups did not differ with regard to total institutional days. Experimental group attrition was relatively high.
In a California county of one million people, 500 clients, 4% of all those served in 1994, were found to use 38% of publicly funded mental health services. A controlled experiment was designed to test whether a capitated Assertive Community Treatment (ACT) program could produce outcomes that were equivalent or better than "usual services" for a subset of very-high-utilizing clients while reducing costs. Results showed that major challenges in using an ACT program for cost reduction were successfully met. Costs over all 4 years were substantially lower for the experimental group than for a randomly assigned comparison group.
The writing that follows is a part theoretical, part-discursive response to a site of Holocaust memory and is an interaction with extracts from my ongoing journals. It is an examination of how established positions of objectivity and subjectivity as defined by the traditional academic thesis can be challenged when fused with practice and explores whether there are ways of bridging the gap between different writing genres in order for new forms to emerge. The article discusses writing as a further agency of my creative practice, its potential as an artistic form and as an additional method of critical enquiry. The article then investigates how the gesture of drawing as a projection of the body and the mediator between mind and world is an alternative vehicle to be ‘with’ and encounter the topography of the Holocaust. In relation to events as ineffable as the Holocaust, the article concludes by looking at how, by reaching for meaning through written or arts practice, we can perhaps begin to determine a contribution to what is, as Ava Hoffman describes in her book After Such Knowledge, an appropriate and measured response before, as we approach a time without living survivors, the Holocaust passes fully into history and myth.
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