Browsing by Author "Lowder, Evan M."

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    Barriers and facilitators to implementing an urban co-responding police-mental health team
    (Springer, 2018-11-22) Bailey, Katie; Paquet, Staci Rising; Ray, Bradley R.; Grommon, Eric; Lowder, Evan M.; Sightes, Emily; School of Public and Environmental Affairs
    BackgroundIn an effort to reduce the increasing number of persons with mental illness (PMI) experiencing incarceration, co-responding police-mental health teams are being utilized as a way to divert PMI from the criminal justice system. Co-response teams are typically an inter-agency collaboration between police and mental health professionals, and in some cases include emergency medical personnel. These teams are intended to facilitate emergency response by linking patients to mental health resources rather than the criminal justice system, thus reducing burdens on both the criminal justice systems as well as local healthcare systems. The current study examines the barriers and facilitators of successfully implementing the Mobile Crisis Assistance Team model, a first-responder co-response team consisting of police officers, mental health professionals, and paramedics. Through content analysis of qualitative focus groups with team members and interviews with program stakeholders, this study expands previous findings by identifying additional professional cultural barriers and facilitators to program implementation while also exploring the role of clear, systematic policies and guidelines in program success.ResultsFindings demonstrate the value of having both flexible and formal policies and procedures to help guide program implementation; ample community resources and treatment services in order to successfully refer clients to needed services; and streamlined communication among participating agencies and the local healthcare community. A significant barrier to successful program implementation is that of role conflict and stigma. Indeed, members of the co-response teams experienced difficulty transitioning into their new roles and reported negative feedback from other first responders as well as from within their own agency. Initial agency collaboration, information sharing between agencies, and team building were also identified as facilitators to program implementation.ConclusionThe current study provides a critical foundation for the implementation of first-responder police-mental health co-response teams. Cultural and systematic barriers to co-response team success should be understood prior to program creation and used to guide implementation. Furthermore, attention must be directed to cultivating community and professional support for co-response teams. Findings from this study can be used to guide future efforts to implement first-response co-response teams in order to positively engage PMI and divert PMI from the criminal justice system.
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    Correlates of suicide risk among Black and White adults with behavioral health disorders in criminal-legal systems
    (Springer Nature, 2022-03-04) Lawson, Spencer G.; Lowder, Evan M.; Ray, Bradley; School of Public and Environmental Affairs
    Background: Adults with behavioral health disorders in criminal-legal systems are at heightened risk of suicide relative to the general population. Despite documented racial disparities in criminal processing and behavioral health treatment, few studies have examined racial differences in suicide risk in this already high-risk population. This study examined 1) the correlates of suicide risk in this population overall and by race and 2) the moderating role of race in these associations. Methods: We investigated correlates of clinician-rated suicide risk at baseline in a statewide sample of 2,827 Black and 14,022 White adults with criminal-legal involvement who engaged in community-based behavioral health treatment. Regression-based approaches were used to model suicide risk and test for evidence of interaction effects. Results: Findings showed the strongest correlates of suicide risk were greater behavioral health needs, evidence of self-harm, and a primary mental health diagnosis or co-occurring diagnosis. In race-specific analyses, correlates of suicide risk were mostly similar for both Black and White clients, with a couple exceptions. Interaction terms testing between-group effects on correlates of suicide risk were non-significant. Conclusions: Adults with behavioral health disorders in criminal-legal systems experience similar risk factors for suicide as the general population. Similar to prior research, we found that Black adults, in particular, are at lower risk for suicide overall. Contrary to expectations, we found similarities in correlates of suicide risk across race in our sample of felony-level adults with behavioral health disorders in the criminal-legal system. Prior research shows that behavioral health professionals should be cognizant of cultural factors when developing a comprehensive approach to suicide care and treatment. Our findings show correlates of suicide risk are largely stable in Black and White adults involved in criminal-legal systems, suggesting culturally responsive treatment for suicide risk should target shared risk factors.
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    Five-County Validation of the Indiana Risk Assessment System – Pretrial Assessment Tool (IRAS-PAT) using a Local Validation Approach
    (Taylor & Francis, 2020) Lowder, Evan M.; Lawson, Spencer G.; Grommon, Eric; Ray, Brad R.; School of Public and Environmental Affairs
    Local jurisdictions are increasingly using pretrial risk assessment instruments to assess risk of pretrial misconduct and inform release decisions. We adopted a local validation approach to examine the predictive validity of Indiana Risk Assessment System – Pretrial Assessment Tool (IRAS-PAT) assessments in 3,739 unique pretrial defendants across five Indiana counties. Jail, court, and pretrial risk assessment records were matched within each jurisdiction to examine pretrial misconduct outcomes (i.e., any arrest, any new arrest, and any failure to appear) during the case processing period. Area Under the Curve (AUC) estimates showed good-to-excellent levels of predictive accuracy for total scores for all outcomes (AUC Range: 0.67-0.72). Multivariable models showed defendants assessed at High (OR Range: 5.42-8.62) and Moderate (OR Range: 2.56-3.08) risk had higher rates of pretrial misconduct relative to those assessed at Low risk. Findings provide strong evidence for the predictive accuracy of IRAS-PAT assessments overall, though some item-level considerations are noted.
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    Identifying Unreported Opioid Deaths Through Toxicology Data and Vital Records Linkage: Case Study in Marion County, Indiana, 2011–2016
    (American Public Health Association, 2018-12) Lowder, Evan M.; Ray, Bradley R.; Huynh, Philip; Ballew, Alfarena; Watson, Dennis P.; School of Public and Environmental Affairs
    Objectives. To demonstrate the severity of undercounting opioid-involved deaths in a local jurisdiction with a high proportion of unspecified accidental poisoning deaths. Methods. We matched toxicology data to vital records for all accidental poisoning deaths (n = 1238) in Marion County, Indiana, from January 2011 to December 2016. From vital records, we coded cases as opioid involved, specified other substance, or unspecified. We extracted toxicology data on opioid substances for unspecified cases, and we have reported corrected estimates of opioid-involved deaths after accounting for toxicology findings. Results. Over a 6-year period, 57.7% of accidental overdose deaths were unspecified and 34.2% involved opioids. Toxicology data showed that 86.8% of unspecified cases tested positive for an opioid. Inclusion of toxicology results more than doubled the proportion of opioid-involved deaths, from 34.2% to 86.0%. Conclusions. Local jurisdictions may be undercounting opioid-involved overdose deaths to a considerable degree. Toxicology data can improve accuracy in identifying opioid-involved overdose deaths. Public Health Implications. Mandatory toxicology testing and enhanced training for local coroners on standards for death certificate reporting are needed to improve the accuracy of local monitoring of opioid-involved accidental overdose deaths.
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    Validating Imputation Procedures to Calculate Corrected Opioid-Involved Overdose Deaths, Marion County, Indiana, 2011-2016
    (Sage, 2020-01) Gupta, Sumedha; Cohen, Alex; Lowder, Evan M.; Ray, Bradley R.; Economics, School of Liberal Arts
    Objectives: Understanding the scope of the current opioid epidemic requires accurate counts of the number of opioid-involved drug overdose deaths. Given known errors and limitations in the reporting of these deaths, several studies have used statistical methods to develop estimates of the true number of opioid-involved overdose deaths. This study validates these procedures using a detailed county-level database of linked toxicology and vital records data. Methods: We extracted and linked toxicology and vital records data from Marion County, Indiana (Indianapolis), during a 6-year period (2011-2016). Using toxicology data as a criterion measure, we tested the validity of multiple imputation procedures, including the Ruhm regression-based imputation approach for correcting the number of opioid-involved overdose deaths. Results: Estimates deviated from true opioid-involved overdose deaths by 3% and increased in accuracy during the study period (2011-2016). For example, in 2016, 231 opioid-involved overdose deaths were noted in the toxicology data, whereas the corresponding imputed estimate was 233 opioid-involved overdose deaths. A simple imputation approach, based on the share of opioid-involved overdose deaths among all drug overdose deaths for which the death certificate specified ≥1 drug, deviated from true opioid-involved overdose deaths by ±5%. Conclusions: Commonly used imputation procedures produced estimates of the number of opioid-involved overdose deaths that are similar to the true number of opioid-involved overdose deaths obtained from toxicology data. Although future studies should examine whether these results extend beyond the geographic area covered in our data set, our findings support the continued use of these imputation procedures to quantify the extent of the opioid epidemic.