The Jail Inreach Project is a health care-based intensive case management "inreach" program that engages incarcerated persons from the homeless population who have behavioral health disorders (mental illness, substance use disorder, or both) in establishing a plan for specific postrelease services. The Jail Inreach Project aims to provide continuity of care and integrate this highly marginalized subpopulation of homeless persons into primary and behavioral health care systems by establishing patient-centered health homes. The use of integrated primary and behavioral health models in conjunction with provisions for immediate access to and continuity of care upon release is emerging as a best practice in combating the rapid cycling of this vulnerable population between streets and shelters, emergency centers, and the county jail. Preliminary results indicate that more than half of the persons referred to the program remained successfully linked with services postrelease, whereas slightly less than one-third who engaged in services while incarcerated did not retain linkage on release.

Many jail releasees have persistent physical and mental health needs that are frequently unaddressed, leading to high rearrest rates and return to jail. This article details the potential benefits and challenges of integrated health services during transition planning and return to the community and details lessons learned from a pilot program in Houston, Texas. It examines how patient-centered medical homes, a modality supported by policy changes at the federal level, provide one means of effective transition from jail to the community that integrates behavioral health services with primary care. Evidence from the pilot program suggests that effective integrated health services for jail releasees can help divert individuals from a cycle of recidivism.

The Jail Inreach Project was initiated in 2007 as a pilot program by Healthcare for the Homeless-Houston, an FQHC serving homeless individuals in Harris County, Texas, as a collaborative effort with the Harris County Sheriff's Office and the Mental Health Mental Retardation Authority of Harris County. It addresses the disproportionate number of homeless individuals with behavioral health diagnoses cycling through the Harris County Jail without provisions for continuity of care. Throughout the years, several evaluations have been conducted to inform programmatic planning and assess the success of the program on affecting patterns of recidivism of mentally ill homeless clients being served. Findings reinforce the importance of linking releasees to services immediately upon release as a measure for breaking the cycle of repeated incarceration and chronic homelessness. This paper illuminates characteristics of a successful intervention by examining three program evaluations conducted at different times in the program's history. It further illustrates how program evaluation has been utilized to help shape the program design and related policies.

Serious mental illness usually first occurs in young adults between the ages o f 18 and 25, and often disrupts the completion o f normal developmental tasks. Young adults making career plans, attending college and/or vocational school, frequently drop out after the onset o f psychiatric illness. Their attempts to return to the postsecondary environment to complete their studies are, more often than not, unsuccessful. These failures are largely due to the lack o f support available at colleges or through mental health systems. The Houston Community College System and the Mental Health and Mental Retardation Authority o f Harris County have combined efforts and resources in an attempt to make the college setting more accommodating to the psychiatrically disabled student. The accommodations can be seen through the development o f programs such as the Community Service Aide Training Program (a 1-year program in which the student receives 27 college credits and a certificate after completing the program), and the Entry/Re-entry Program (designed to facilitate entry and/or return o f a student to a postsecondary environment). An Office o f Supported Education for Psychiatrically Disabled Students has also been established. The office not only oversees the above programs but ensures that students who are enrolled in other programs receive reasonable accommodations as well as the supports necessary to improve their chances 42 Psychosocial Rehabilitation JournalThis document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Despite a need to improve community mental health services for youths, little is known about compliance with state policies created to improve the quality of services in these settings. This study examined rates, patterns, and predictors of compliance with utilization management guidelines developed by the state of Texas to support a public health policy based on empirical evidence of effective mental health services (i.e., an evidence-based policy). Compliance was defined as authorizing policy-recommended service packages, whereas policy “overrides” occurred when recommended service packages were not authorized. The study sample consisted of 688 youths from ethnically and economically diverse backgrounds. Clinics reported that forty-six percent of youths were not authorized the policy-recommended service package. Overrides were primarily based on level of intensity. Most often, authorized services were less intensive than those recommended by the state guidelines. Higher severity at intake across multiple indicators was associated with authorizing less intensive services than what the policy guidelines recommended. Future studies evaluating system-level efforts such as state mental health policies should pay close attention to levels of service intensity, and their relation to the needs of youth in community settings.

No abstract

This column describes and evaluates the Harris County Community Behavioral Health Program, a new integrated care program operating in community health centers serving low-income uninsured residents in Houston, Texas. Patient service data, provider satisfaction, patient outcome data, and appointment waiting periods were obtained to evaluate the initial operation of the program. The integrated care program has been successfully implemented on a large scale at an annual cost of about dollars 800,000, or dollars 268 per patient served. About 3,000 patients were treated for behavioral problems by behavioral health staff during the first 11 months of the program. In addition, efforts were made to expand the scope of behavioral health interventions provided by primary care physicians. Providers were satisfied with the program, improvement was detected among patients treated, and there was an increase in the average number of community-based behavioral health services received per patient since the program was implemented.

Rating scales are useful for evidence-based assessment of youth psychopathology. However, it is not known whether these scales contribute information beyond that which clinicians gather without them. This study examined agreement between chart diagnoses and the Child Behavior Checklist (CBCL) for 82 community mental health clinic clients. Agreement was low, suggesting that the CBCL was not redundant with clinicians' clinical impressions. These findings suggest that use of an instrument like the CBCL could potentially improve clinician diagnostic accuracy; future research should examine how best to utilize these scales in the diagnostic process and how to train clinicians in their use.