Rural Jails and Behavioral Health: Clinical and Policy Implications
Norman Hoffmann, PhDa,b & Al Kopak, PhDa
aWestern Carolina University
bEvince Diagnostics, LLC
Although we have published extensively on our findings from rural jails, those publications do not fully address some of the policy implications of the findings. Similarly, experience with the online assessment system provides additional options for jurisdictions to identify and document behavioral health conditions.
Since most arrestees appear to not have current coverage for services, some type of funding is required for providers to be reimbursed. In several counties, there are no identified providers willing or able to provide services given the current reimbursement situation. Some form of bridge funding from county resources for coverage before Medicaid or other standard funding, if available, might actually provide a net county benefit via savings on incarceration costs that tend to be more than $80 per day of incarceration. Even if only some cases of recidivism can be avoided by addressing behavioral health conditions, financial as well as societal benefits might offset at least some treatment costs.
With the online CAAPE-5, the nurses or paraprofessionals who do the mandated workup of arrestees could administer the interview given a positive screen on the UNCOPE, a six-item screen initially validated on arrestees. The system produces a report as a pdf file and the item responses are stored on a de-identified statistical file. This facilitates both clinical referrals and statistical documentation of prevalence rates.
On a totally different topic, our analyses of positive DSM-5 criteria from another structured interview have identified five of the eleven criteria that seem to be more strongly associated with a severe condition. Those five criteria are unsuccessful attempts to cut down/quit, cravings, failure to fulfill role obligations, sacrificing social, occupational, etc. activities due to use, and withdrawal.
One possibility is that those positive for one or more of these five criteria will require a goal of abstinence for long-term recovery. The corollary is that those who are not positive for any of the five may be successful at moderation. This might be useful in helping patients make decisions about approaches to recovery. However, there is no empirical study on the implications of these criteria at this time.
The citation for the article that summarizes the findings for alcohol and references similar articles on cannabis and cocaine is:
Hoffmann, N. G. & Kopak, A. M. (2015). How well do the DSM-5 alcohol use disorder designations map to the ICD-10 Disorders? Alcoholism: Clinical and Experimental Research, online DOI: 10.1111/acer.12685