Types of Partner Violence in Couples Affected by Incarceration: Applying Johnson's Typology to Understand the Couple-level Context for Violence.

In prior research, samples of incarcerated and reentering men and their partners report partner violence at roughly 10 times the frequency found in the general population. The relationship dynamics underlying these experiences remain poorly understood. Addressing this gap and expanding prior applications of Johnson's typology in other populations-which typically rely on survey data alone and include reports from just one member of a couple-we applied latent class analysis with dyadic survey data from 1,112 couples to identify types of partner violence in couples affected by incarceration. We assessed congruence between quantitative types and couples' qualitative accounts and compared the two major types using two-sample t-tests.In some couples, one partner used various tactics to systematically dominate and control the other, as in Johnson's coercive controlling violence. In others, physical violence arose in the context of jealousy but no other controlling behavior. This type resembled Johnson's situational couple violence. Qualitative data suggested that jealousy represented a common, situational response to periods of prolonged separation, relationship instability, status insecurity, and partnership concurrence and not a tactic of control per se. Victims of coercive controlling violence experienced more PTSD symptoms and felt less safe in their relationships than victims of jealous-only violence. Perpetrators of coercive controlling violence were more likely to use severe physical violence against their partners than perpetrators of jealous-only violence. Findings indicate that broader context is critical for interpreting the presence of jealousy (and whether it constitutes a control tactic). They indicate that prevention and response strategies tailored to these types could help couples cope safely with the extreme relationship stressors of incarceration and reentry. Finally, they suggest a need to move from an exclusive focus on individual accountability and services toward a model that also incorporates institutional accountability and change.

A Field Test of Opportunities for Teen Dating Violence Disclosure in School-Based Relationship Education Programs.

School-based relationship education programs offer an opportunity to identify youth who are experiencing teen dating violence (TDV), support their safety, and connect them with individualized services or referrals. However, no research has tested the feasibility or accuracy of approaches to create opportunities for TDV disclosure in the context of school-based programs. The current study presents the results of a field test comparing three tools used to provide opportunities for TDV disclosure (two questionnaire-style tools and one universal education discussion guide). High school students from two federally funded healthy marriage and relationship education (HMRE) program sites (N = 648) were offered the three tools in random order over the course of the HMRE program, which lasted between 3 weeks and 3 months and took place during the school day. Onsite qualitative interviews with HMRE program staff and their local domestic violence program partners assessed how service providers saw the tools and the process of implementing them. Latent class models examined the accuracy of the tools in identifying TDV. Sensitivities of the tools were low and specificities were high; the questionnaire-style tools tended to have higher sensitivities and fewer classification errors than the universal education tool. Several three-item combinations from across the tools performed better than any intact tool, suggesting that shorter assessments may be effective, provided they include items on sexual coercion and physical violence. Qualitative findings suggested that implementation of TDV assessment and universal education in school settings is a viable strategy, provided programs are able to gain support from school staff, adapt to tight time constraints, and plan procedures for protecting student privacy and confidentiality.

Profile of Justice-Involved Marijuana and Other Substance Users: Demographics, Health and Health Care, Family, and Justice System Experiences.

Substance users are more likely to have co-occurring health problems, and this pattern is intensified among those involved with the criminal justice system. Interview data for 1977 incarcerated men in 5 states from the Multi-site Family Study on Incarceration, Parenting, and Partnering that was conducted between December 2008 and August 2011 were analyzed to compare pre-incarceration substance use patterns and health outcomes between men who primarily used marijuana, primarily used alcohol, primarily used other drugs, and did not use any illicit substances during that time. Using regression modeling, we examined the influence of substance use patterns on physical and mental health. Primary marijuana users comprised the largest portion of the sample (31.5%), closely followed by nonusers (30.0%), and those who primarily used other drugs (30.0%); primary alcohol users comprised the smallest group (19.6%). The substance user groups differed significantly from the nonuser group on many aspects of physical and mental health. Findings suggest that even among justice-involved men who are not using "hard" drugs, substance use merits serious attention. Expanding the availability of substance use treatment during and after incarceration might help to promote physical and mental health during incarceration and reentry.

A time and motion study of Screening, Brief Intervention, and Referral to Treatment implementation in health-care settings.

AIMS: Screening and brief intervention for harmful substance use in medical settings is being promoted heavily in the United States. To justify service provision fiscally, the field needs accurate estimates of the number and type of staff required to provide services, and thus the time taken to perform activities used to deliver services. This study analyzed the time spent in activities for the component services of the substance misuse Screening, Brief Intervention and Referral to Treatment (SBIRT) program implemented in emergency departments, in-patient units and ambulatory clinics. DESIGN: Observers timed activities according to 18 distinct codes among SBIRT practitioners. SETTING: Twenty-six US sites within four grantees. PARTICIPANTS: Five hundred and one practitioner-patient interactions; 63 SBIRT practitioners. MEASUREMENTS: Timing of practitioner activities. INTERVENTIONS: Delivery of component services of SBIRT. FINDINGS: The mean (standard error) time to deliver services was 1:19 (0:06) for a pre-screen (n = 210), 4:28 (0:24) for a screen (n = 97) and 6:51 (0:38) for a brief intervention (n = 66). Estimates of service duration varied by setting. Overall, practitioners spent 40% of their time supporting SBIRT delivery to patients and 13% of their time delivering services. CONCLUSIONS: In the United States, support activities (e.g. reviewing the patient's chart, locating the patient, writing case-notes) for substance abuse Screening, Brief Intervention and Referral to Treatment require more staff time than delivery of services. Support time for screens and brief interventions in the emergency department/trauma setting was high compared with the out-patient setting.

The cost-effectiveness of brief intervention versus brief treatment of Screening, Brief Intervention and Referral to Treatment (SBIRT) in the United States.

AIMS: To conduct a cost-effectiveness analysis (CEA) comparing the delivery of brief intervention (BI) with brief treatment (BT) within Screening, Brief Intervention and Referral to Treatment (SBIRT) programs. DESIGN: Quasi-experimental differences in observed baseline characteristics between BI and BT patients were adjusted using propensity score techniques. Incremental comparison of costs and health outcomes associated with BI and BT. SETTING: Health-care settings in four US states participating in Substance Abuse and Mental Health Services Administration SBIRT grant programs. PARTICIPANTS: Ninety patients who received BT and 878 who received BI. MEASUREMENTS: Per-patient cost of SBIRT, patient demographics and six measures of substance use: proportion using alcohol, proportion using alcohol to intoxication, days of alcohol use, days of alcohol use to intoxication, proportion using drugs and days using drugs. FINDINGS: BI and BT were associated with better outcomes. The cost of SBIRT was significantly higher for BT patients ($75.54 versus 16.32, 95% confidence interval, P < 0.01). BT would be cost-effective if the decision-maker had a willingness to pay of $8.90 for a 1 percentage point reduction in the probability of using any alcohol. For the other five outcomes, BT was less effective and more costly, and BI would be a better use of resources. CONCLUSIONS: It might be cost-effective to offer brief treatment if the goal is to abstain from alcohol. However, the higher effectiveness of brief treatment for this outcome is associated with considerable uncertainty and, because both brief intervention and brief treatment improve all outcomes, brief treatment does not appear to be a good use of resources.

Using social media to monitor mental health discussions - evidence from Twitter.

OBJECTIVES: Given the public health importance of communicating about mental illness and the growing use of social media to convey information, our goal was to develop an empirical model to identify periods of heightened interest in mental health topics on Twitter. MATERIALS AND METHODS: We collected data on 176 million tweets from 2011 to 2014 with content related to depression or suicide. Using an autoregressive integrated moving average (ARIMA) data analysis, we identified deviations from predicted trends in communication about depression and suicide. RESULTS: Two types of heightened Twitter activity regarding depression or suicide were identified in 2014: expected increases in response to planned behavioral health events, and unexpected increases in response to unanticipated events. Tweet volume following expected increases went back to the predicted level more rapidly than the volume following unexpected events. DISCUSSION: Although ARIMA models have been used extensively in other fields, they have not been used widely in public health. Our findings indicate that our ARIMA model is valid for identifying periods of heightened activity on Twitter related to behavioral health. The model offers an objective and empirically based measure to identify periods of greater interest for timing the dissemination of credible information related to mental health. CONCLUSION: Spikes in tweet volume following a behavioral health event often last for less than 2 days. Individuals and organizations that want to disseminate behavioral health messages on Twitter in response to heightened periods of interest need to take this limited time frame into account.

Cost of Screening, Brief Intervention, and Referral to Treatment in Health Care Settings.

AIMS: This study analyzed service unit and annual costs of substance abuse screening, brief intervention, and referral to treatment (SBIRT) programs implemented in emergency department (ED), inpatient, and outpatient medical settings in three U.S. states and one tribal organization. METHODS: Unit costs and annual costs were estimated from the perspective of service providers. Data for unit costs came from 26 performance sites, and data for annual costs came from 10 programs. A bottom-up approach was used to derive unit costs and included labor, space, and materials used in each SBIRT activity. Activities included direct SBIRT services and activities that support direct service delivery. Labor time spent in each activity was collected by trained observers using a time-and-motion approach. A top-down approach used cost questionnaires completed by program administrators to calculate annual costs and included labor, space, contracted services, overhead, training, travel, equipment, and supplies and materials. Costs were estimated in 2012 U.S. dollars. RESULTS: Average unit costs for prescreening, screening, brief intervention, brief treatment, and referral to treatment were $0.61, $6.59, $10.48, $22.63, and $12.06 in ED; $0.86, $6.33, $9.07, $27.61, and $8.03 in inpatient; and $0.84, $3.98, $7.81, $27.94, and $9.23 in outpatient settings, respectively; over half of the costs were attributable to support activities. Across all settings, the average cost to provide SBIRT per positive screen, for 1year, was about $400. CONCLUSIONS: Support activities comprise a large proportion of costs. Health administrators can use the results to budget and compare how much sites are reimbursed for SBIRT to how much services actually cost.