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| Name | Class |
|---|---|
| Michigan State University | OTHER |
| Mount Auburn Hospital | OTHER |
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The proposed Center will leverage burgeoning real-time data linkage capabilities among health systems, Medicaid payors, and criminal legal (e.g., jail booking data, jail release data) systems, to identify individuals coming in and out of jail for suicide assessment and prevention, and to better coordinate care across these disparate systems. This Center will advance the fields of suicide prevention and criminal legal system-based mental health by solving a well-known, central problem in both fields: the inability to track and intervene with individuals moving in and out of both and often multiple systems. The goal is near-term reductions in the U.S. suicide rate.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment as usual (TAU) | Experimental | This arm will consist of 2160 eligible individuals identified to have had criminal legal involvement in Cambridge Health Alliance catchment area cities other than Cambridge (Everett, Somerville, Malden, Medford, Chelsea, Revere, Winthrop). Police departments in these Treatment as Usual cities have no programs that link police officers and clinicians to follow up on safety planning and services. These individuals will be identified as having police involvement between 2009 and 2025. |
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| FSJS | Experimental | Consists of 200 Cambridge Health Alliance Patients Ages 18-100 Individuals who have come into contact with the Cambridge Police Department (as identified in the FSJS data) between 2009 and 2025. |
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| FSJS + Navigator | Experimental | 40 patients recruited during the study period in the Cambridge Health Alliance Emergency Department (ED) Ages 18-100 Individuals who are brought into the ED under police supervision (excluding individuals currently incarcerated) involuntarily brought to the ED for psychiatric evaluation because they are considered to be a risk to themselves or others (MA Law 123(12)); or the subject of a police call for service for a mental health issue who are willingly admitted to the ED |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Treatment as usual (TAU) | Other | TAU patients will be identified using "targeted limited chart review methods" used in our prior studies, "scraping" clinical notes in the EHR for criminal legal involvement. Initial Identification terms, "police", "arrest", "court", "summons", "jail", and "crime" will be used to identify candidates for police involvement, downloading the sentence in which the keyword appeared and the sentence before and after. Next, an iterative process of editing of the search terms will be conducted to remove patients with negation of the keyword ("did not commit a crime"), and other sentence characteristics that generate false positives ("cardiac arrest"). Samples of the resulting dataset will be taken, accuracy assessed by examining the surrounding sentences, leading to further iterations and repetition of the process until a high level of accuracy is achieved. |
| Measure | Description | Time Frame |
|---|---|---|
| Past-year medically treated suicide attempt at baseline and 12 months | Number of participants with a past-year medically treated suicide attempt. This will be measured at baseline and 12 months will be collected using the electronic health record (EHR) data. | Baseline and 12 months |
| Suicide Severity and Behaviors using Computerized Adaptive Test Suicide Scale (CAT-SS) at Baseline and 12 Months | The CAT-SS measures Severity of Suicide Risk will be assessed using CAT-SS, providing severity on a 0-100 point scale, and risk-stratification to negligible, intermediate and high risk. It is highly sensitive and specific to the Columbia Suicide Severity Rating Scale, and predicts future suicide events with high precision and accuracy. | Baseline and 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Individual Interactions with the Criminal Legal System at Baseline and 12 Months | Number of calls about each individual to the Cambridge Police Department (CPD) Number of arrests Number of admissions to the Middlesex County Jail Repeat admission to the Middlesex County Jail | From enrollment through 12 months |
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Inclusion Criteria:
Treatment as Usual (TAU) arm
FSJS arm
FSJS+Navigator arm
Recruited during the study period in the CHA ED
Ages 18-100
Individuals who are brought into the Emergency Department under police supervision (excluding individuals currently incarcerated)
Exclusion Criteria
Treatment as Usual (TAU) arm
FSJS arm
FSJS+Navigator arm
Under the age of 18
Any individual who becomes incarcerated during the course of the study
Individuals who enter the Emergency Department not under police supervision
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Benjamin Cook | Contact | 617-806-8741 | bcook@cha.harvard.edu | |
| Taylor Witkowski | Contact | 617-806-8751 | twitkowski@challiance.org |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cambridge Health Alliance | Recruiting | Cambridge | Massachusetts | 02141 | United States |
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| ID | Term |
|---|---|
| D001523 | Mental Disorders |
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| ID | Term |
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| D013812 | Therapeutics |
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Preliminary effectiveness of FSJS+Navigator model on suicide severity and clinical outcomes using CAT-SS/MH, mental health, and mental health treatment/criminal legal outcomes will be assessed. Assessments occur at baseline, 1, 3, and 6 months, providing key statistics (distribution, correlation of outcome over time, missingness) needed to inform a fully-powered Hybrid II trial. Improvement in medically treated suicide attempts and CAT-SS indicators will be assessed over time using repeated measures ANOVA. This study is a non-experimental longitudinal design comparing treatment group (FSJS+Navigator) to 2 control groups (FSJS Only and Treatment As Usual). We will assess the following as moderators of intervention effects: sex, race/ethnicity, past suicide attempt, past behavioral health treatment, Area Deprivation index, mental health professional shortage area score, per capita incarceration, and other area-level social determinants of health variables using stratified and DDD models.
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| FSJS | Other | Documentation and follow-up by the Cambridge Police Department (CPD) for all mental health-related police calls, including involuntary and voluntary Emergency Department admissions; Established partnerships with city departments, healthcare systems, clergy, courts, businesses, and mental health advocates to ensure timely engagement in mental health treatment and community-based services; Required 40 hours of officer crisis intervention training (CIT), and additional sessions on trauma- informed policing, mental health, race, and crisis negotiation; and Staffing of sworn and civilian staff including specially-trained officers designated to work with individuals living with mental illness, homelessness, and substance abuse. |
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| FSJS+Navigator Intervention | Other | The FSJS+Navigator intervention adds an Emergency Department (ED)-based Systems Navigator, a community health worker with lived experience (as family member or patient) with criminal legal and mental health systems, to the FSJS. This navigator will enhance communication between Cambridge Police Department (CPD), Cambridge Health Alliance (CHA), and community agencies by being the needed "point person" within the healthcare system (the FSJS intervention only has a CPD-based social worker) to maintain communication to improve mental health services and prevent deeper legal involvement. The Navigator engages with the FSJS process in step i) of the above sequence, engaging the patient in the CHA ED and obtaining consent. The Navigator then discusses the case with the presenting CPD officer, and relays critical information about the context of the service call to ED staff. Next, the Navigator will administer the baseline CAT-MH/SS and assess additional needs (employment, housing, food). |
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| Number of Individual Interactions between Hospitals and the Criminal-Legal System at Baseline and 12 Months |
Number of involuntary hospitalizations that require Cambridge Police Department (CPD) interaction |
| From enrollment through 12 months |
| Frequency of Healthcare Services Used by Patients at Baseline and 12 Months | Number of Emergency Department visits Number of behavioral health inpatient visits Number of behavioral health outpatient mental health (MH) visits | From enrollment through 12 months |