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Summaries of RCT Grants

RCT of Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment (FACT) for high utilizers of hospitals and jails in Dallas County

This grant will fund a randomized controlled trial (RCTs) of evidence-based programs – ACT and FACT – for justice-involved individuals with serious mental illness who are high utilizers of hospitals and/or jails in Dallas County.

Grant Recipient: Meadows Mental Health Policy Institute

Term: 2017 –2022

Principal Investigators: John Petrila, LL.M., Meadows Mental Health Policy Institute
Jennifer Skeem, Ph.D., University of California, Berkeley

Funding: $1,024,737

Summary: This grant will fund a randomized controlled trial (RCTs) of evidence-based programs – ACT and FACT – for justice-involved individuals with serious mental illness who are high utilizers of hospitals and/or jails in Dallas County.

ACT is an evidence-based program for people with serious mental illnesses and substance use disorders who are high utilizers of hospitals. ACT is delivered by a transdisciplinary team of 10 to 12 practitioners who provide services to about 100 people, and work to engage clients in treatment and directly provide 24/7 services and support in the community. Although prior studies suggest ACT reduces hospitalization and improves other clinical outcomes, it does not necessarily reduce police contacts and arrests. For this reason, offenders with moderate to high risk of recidivism will be assigned to FACT teams, which add a probation officer to ACT’s standard multidisciplinary clinical team.

Dallas County will be delivering ACT and FACT as part of a larger Smart Justice initiative, whose implementation is being funded by a $7 million grant from the W.W. Caruth Jr. Foundation as well as state and local funding. The ACT/FACT model has been previously evaluated in small RCTs and matched quasi-experiments, which have found promising reductions in hospitalizations and/or criminal arrests for high utilizers.

The RCT will evaluate ACT and FACT in a sample of approximately 1,000 justice-involved high healthcare utilizers. Sample members will be randomly assigned to receive either Smart Justice (where those who are determined to be at low risk of recidivism will receive ACT, and those determined to be at high risk of recidivism will receive FACT) or services as usual. The study will measure service utilization and cost – i.e., hospitalizations, emergency department visits, and arrests – over a two-year period as the primary outcomes.

The study’s pre-specified analysis plan is linked here.

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