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Pease, Ken. "Community Service Orders." Crime and Justice 6 (January 1985): 51–94. http://dx.doi.org/10.1086/449104.
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Nakhost, Arash, Frank Sirotich, Katherine M. Francombe Pridham, Vicky Stergiopoulos, and Alexander I. F. Simpson. "Coercion in Outpatients under Community Treatment Orders: A Matched Comparison Study." Canadian Journal of Psychiatry 63, no. 11 (April 3, 2018): 757–65. http://dx.doi.org/10.1177/0706743718766053.
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Objective: Since the deinstitutionalization of psychiatric services around the world, the scope of outpatient psychiatric care has also increased to better support treatment access and adherence. For those with serious mental illness who may lack insight into their own illness, available interventions include coercive community practices such as mandated community treatment orders (CTOs). This paper examines the perceptions of coercion among service users treated with a CTO. Method: We used a cross-sectional comparative design where service users treated under a CTO were matched to a comparison group of voluntary psychiatric outpatients. Both groups were receiving intensive community mental health services ( n = 69 in each group). Participants were interviewed using a series of questionnaires aimed at evaluating their perceptions of coercion and other aspects of the psychiatric treatment. Results: The level of coercion reported by service users treated under a CTO was significantly higher than that in the comparison group. However, in adjusted analyses, service users’ perception of coercion, irrespective of their CTO status, was directly correlated with their previous experience with probation and inversely correlated with the sense of procedural justice in their treatment. Conclusions: Evaluation of psychiatric service users’ experiences of coercion should consider their past and current involvement with other types of coercive measures, particularly history of probation. Clinicians may be able to minimize these experiences of coercion by incorporating procedural justice principles into their practice.
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Milne, Duncan, Anthony O'Brien, and Brian McKenna. "Community Treatment Orders and Competence to Consent." Australasian Psychiatry 17, no. 4 (January 1, 2009): 273–78. http://dx.doi.org/10.1080/10398560902721572.
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Objective: The aim of this paper is to explore the relationship between civil commitment under a Community Treatment Order (CTO) and competence to consent to treatment. Method: A purposive convenience sample of 10 service users under CTOs were interviewed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Ratings were compared with the ratings of 10 matched voluntary service users. Results: Seventy percent of the CTO sample were found to be incompetent according to the MacCAT-T, compared to 20% of the comparison group ( p = 0.004). The proportion of the CTO sample found to be incompetent reduces to 50% if the subscale of appreciation is excluded ( p = 0.004). Most people in each group would elect to continue their current treatment if given the choice. Conclusion: Findings of this study suggest that mental health law reform introducing considerations of competence could lead to a substantially different group of people being subject to CTOs. If the CTO is carefully targeted and not used excessively, it is likely to be accorded qualified acceptance for most service users for whom it is used.
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Menzies, Ken. "The Rapid Spread of Community Service Orders in Ontario." Canadian Journal of Criminology 28, no. 2 (April 1986): 157–69. http://dx.doi.org/10.3138/cjcrim.28.2.157.
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Patel, Gunvant. "Community Treatment Orders in Victoria: A Clinico-Ethical Perspective." Australasian Psychiatry 16, no. 5 (January 1, 2008): 340–43. http://dx.doi.org/10.1080/10398560802233017.
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Objective: The aim of this paper is to outline the impact of Community Treatment Orders over a 20-year period on service delivery and clinical practice in Victoria. Conclusions: Community Treatment Orders, as utilized in Victoria, have undermined optimal service delivery and supported paternalistic, reductionistic clinical practice. The psychiatric profession has failed to advocate adequately for better mental health resourcing and human rights protection of those subject to Community Treatment Orders.
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Kilcommins, Shane. "The Introduction of Community Service Orders: Mapping its ‘Conditions of Possibility’." Howard Journal of Criminal Justice 53, no. 5 (August 6, 2014): 487–510. http://dx.doi.org/10.1111/hojo.12096.
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Perera, Bhathika, Abdul Shaikh, and Niraj Singh. "The use of Community Treatment Orders in an intellectual disability service." Advances in Mental Health and Intellectual Disabilities 7, no. 3 (May 10, 2013): 129–34. http://dx.doi.org/10.1108/20441281311320701.
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Owens, Nicholas, and Lisa Brophy. "Revocation of Community Treatment Orders in a mental health service network." Australasian Psychiatry 21, no. 1 (December 12, 2012): 46–50. http://dx.doi.org/10.1177/1039856212470504.
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Weich, Scott, Craig Duncan, Liz Twigg, Orla McBride, Helen Parsons, Graham Moon, Alastair Canaway, et al. "Use of community treatment orders and their outcomes: an observational study." Health Services and Delivery Research 8, no. 9 (February 2020): 1–76. http://dx.doi.org/10.3310/hsdr08090.
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Background Community treatment orders are widely used in England. It is unclear whether their use varies between patients, places and services, or if they are associated with better patient outcomes. Objectives To examine variation in the use of community treatment orders and their associations with patient outcomes and health-care costs. Design Secondary analysis using multilevel statistical modelling. Setting England, including 61 NHS mental health provider trusts. Participants A total of 69,832 patients eligible to be subject to a community treatment order. Main outcome measures Use of community treatment orders and time subject to community treatment order; re-admission and total time in hospital after the start of a community treatment order; and mortality. Data sources The primary data source was the Mental Health Services Data Set. Mental Health Services Data Set data were linked to mortality records and local area deprivation statistics for England. Results There was significant variation in community treatment order use between patients, provider trusts and local areas. Most variation arose from substantially different practice in a small number of providers. Community treatment order patients were more likely to be in the ‘severe psychotic’ care cluster grouping, male or black. There was also significant variation between service providers and local areas in the time patients remained on community treatment orders. Although slightly more community treatment order patients were re-admitted than non-community treatment order patients during the study period (36.9% vs. 35.6%), there was no significant difference in time to first re-admission (around 32 months on average for both). There was some evidence that the rate of re-admission differed between community treatment order and non-community treatment order patients according to care cluster grouping. Community treatment order patients spent 7.5 days longer, on average, in admission than non-community treatment order patients over the study period. This difference remained when other patient and local area characteristics were taken into account. There was no evidence of significant variation between service providers in the effect of community treatment order on total time in admission. Community treatment order patients were less likely to die than non-community treatment order patients, after taking account of other patient and local area characteristics (odds ratio 0.69, 95% credible interval 0.60 to 0.81). Limitations Confounding by indication and potential bias arising from missing data within the Mental Health Services Data Set. Data quality issues precluded inclusion of patients who were subject to community treatment orders more than once. Conclusions Community treatment order use varied between patients, provider trusts and local areas. Community treatment order use was not associated with shorter time to re-admission or reduced time in hospital to a statistically significant degree. We found no evidence that the effectiveness of community treatment orders varied to a significant degree between provider trusts, nor that community treatment orders were associated with reduced mental health treatment costs. Our findings support the view that community treatment orders in England are not effective in reducing future admissions or time spent in hospital. We provide preliminary evidence of an association between community treatment order use and reduced rate of death. Future work These findings need to be replicated among patients who are subject to community treatment order more than once. The association between community treatment order use and reduced mortality requires further investigation. Study registration The study was approved by the University of Warwick’s Biomedical and Scientific Research Ethics Committee (REGO-2015-1623). Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 9. See the NIHR Journals Library website for further project information.
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O’Donoghue, B. "Coercion: an understudied issue in mental health." Irish Journal of Psychological Medicine 34, no. 4 (November 23, 2017): 221–22. http://dx.doi.org/10.1017/ipm.2017.70.
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Coercion in mental health services is a controversial practice, yet it is a relatively understudied area. This special themed edition draws upon research from the international community with the aim of addressing issues related to coercion and involuntary admission. The issue covers topics such as community treatment orders, service users’ perspectives, alternative models of involving service users in their treatment, and future directions for coercion research. It is hoped that this edition will encourage funding and inspire future research on this important topic.
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Vine, Ruth, Holly Tibble, Jane Pirkis, Fiona Judd, and Matthew J. Spittal. "Does legislative change affect the use and duration of compulsory treatment orders?" Australian & New Zealand Journal of Psychiatry 53, no. 5 (November 18, 2018): 433–40. http://dx.doi.org/10.1177/0004867418812683.
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Objective: Victoria, Australia, introduced reformed mental health legislation in 2014. The Act was based on a policy platform of recovery-oriented services, supported decision-making and minimisation of the use and duration of compulsory orders. This paper compares service utilisation and legal status after being on a community treatment order under the Mental Health Act 1986 (Vic) with that under the Mental Health Act 2014 (Vic). Methods: We obtained two distinct data sets of persons who had been on a community treatment order for at least 3 months and their subsequent treatment episodes over 2 years under the Mental Health Act and/or as an inpatient for the periods 2008–2010 (Mental Health Act 1986) and 2014–2016 (Mental Health Act 2014). The two sets were compared to assess the difference in use, duration and odds of having a further admission over 2 years. We also considered the mode of discharge – whether by the treating psychiatrist, external body or through expiry. Results: Compared with the Mental Health Act 1986, under the Mental Health Act 2014, index community treatment orders were shorter (mean 227 days compared with 335 days); there was a reduction in the mean number of community treatment orders in the 2 years following the index discharge − 1.1 compared with 1.5 (incidence rate ratio (IRR) = 0.71, 95% confidence interval = [0.63, 0.80]) – and a 51% reduction in days on an order over 2 years. There was a reduction in the number of subsequent orders for those whose order expired or was revoked by the psychiatrist under the Mental Health Act 2014 compared to those under the Mental Health Act 1986. The number of orders which were varied to an inpatient order by the authorised psychiatrist was notably greater under the Mental Health Act 2014. Conclusion: The reformed Mental Health Act has been successful in its intent to reduce the use and duration of compulsory orders in the community. The apparent increase in return to inpatient orders raises questions regarding the intensity and effectiveness of community treatment and context of service delivery.
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Gupta, Susham, Elvan U. Akyuz, Toby Baldwin, and David Curtis. "Community treatment orders in England: review of usage from national data." BJPsych Bulletin 42, no. 3 (April 23, 2018): 119–22. http://dx.doi.org/10.1192/bjb.2017.33.
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Aims and methodCommunity treatment orders (CTOs) have been in used in England and Wales since November 2008; however, their effectiveness has been debated widely, as has the question of which methodology is appropriate to investigate them. This paper uses national data to explore the use of CTOs in England.ResultsAbout 5500 patients are subject to CTOs at any one time. Each year, ~4500 patients are made subject to a CTO each year and ~2500 are fully discharged, usually by the responsible clinician; fewer than half of CTO patients are recalled, and two-thirds of recalls end in revocation. The low rate of CTO discharges by mental health tribunals (below 5%) suggests that they are not used inappropriately.Clinical implicationsThe introduction of CTOs in England has coincided with a reduction in psychiatric service provision due to the economic downturn. Pressures on services might be even more severe if patients currently subject to CTOs instead needed to be detained as in-patients.Declaration of interestNone.
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Lo, T. Wing, and Robert J. Harris. "Community Service Orders in Hong Kong, England, and Wales: Twins or Cousins." International Journal of Offender Therapy and Comparative Criminology 48, no. 3 (June 2004): 373–88. http://dx.doi.org/10.1177/0306624x04263458.
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Rawala, Muffazal, and Susham Gupta. "Use of community treatment orders in an inner-London assertive outreach service." Psychiatric Bulletin 38, no. 1 (February 2014): 13–18. http://dx.doi.org/10.1192/pb.bp.112.042184.
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Aims and methodTo compare admission rates and bed occupancy before and after the introduction of community treatment orders (CTOs) in 37 assertive outreach service patients. The effect of CTOs on treatment adherence and illicit drug use were also evaluated. The views of patients and care coordinators were obtained through a focus group.ResultsWhen CTOs were introduced, admission rates fell from 3.3 to 0.3 per year and average bed occupancy declined from 133.2 to 10.8 days per year. Treatment adherence improved from 4 (10.8%) to 31 (83.7%) patients, and an objective reduction in substance misuse was observed in 25 (67.5%) patients. Whereas patients expressed ambivalence towards CTOs, their care coordinators generally had a more positive view.Clinical implicationsThe decline in hospital usage following the introduction of CTOs is encouraging and could reflect improved adherence and engagement through intensive case management, leading to a reduction in readmissions. However, further studies need to look at quality of life, cost-effectiveness and the impact on patients.
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Stroud, Julia, Laura Banks, and Karolina Doughty. "Community treatment orders: learning from experiences of service users, practitioners and nearest relatives." Journal of Mental Health 24, no. 2 (February 2, 2015): 88–92. http://dx.doi.org/10.3109/09638237.2014.998809.
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Henning, Terese. "Hidden Factors in the Assessment of Offenders for Community Service Orders in Tasmania." Current Issues in Criminal Justice 8, no. 3 (March 1997): 287–316. http://dx.doi.org/10.1080/10345329.1997.12036746.
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Maughan, Daniel, Andrew Molodynski, Jorun Rugkåsa, and Tom Burns. "A systematic review of the effect of community treatment orders on service use." Social Psychiatry and Psychiatric Epidemiology 49, no. 4 (October 18, 2013): 651–63. http://dx.doi.org/10.1007/s00127-013-0781-0.
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Light, Edwina M., Michael D. Robertson, Philip Boyce, Terry Carney, Alan Rosen, Michelle Cleary, Glenn E. Hunt, Nick O'Connor, Christopher J. Ryan, and Ian H. Kerridge. "How shortcomings in the mental health system affect the use of involuntary community treatment orders." Australian Health Review 41, no. 3 (2017): 351. http://dx.doi.org/10.1071/ah16074.
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Objective The aim of the present study was to examine stakeholder perspectives on how the operation of the mental health system affects the use of involuntary community treatment orders (CTOs). Methods A qualitative study was performed, consisting of semi-structured interviews about CTO experiences with 38 purposively selected participants in New South Wales (NSW), Australia. Participants included mental health consumers (n = 5), carers (n = 6), clinicians (n = 15) and members of the Mental Health Review Tribunal of NSW (n = 12). Data were analysed using established qualitative methodologies. Results Analysis of participant accounts about CTOs and their role within the mental health system identified two key themes, namely that: (1) CTOs are used to increase access to services; and (2) CTOs cannot remedy non-existent or inadequate services. Conclusion The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation. What is known about this topic? Following the deinstitutionalisation of psychiatric services over recent decades, community settings are increasingly the focus for the delivery of mental health services to people living with severe and persistent mental illnesses. The rates of use of involuntary treatment in Australian community settings (under CTOs) vary between state and territory jurisdictions and are high by world standards; however, the reasons for variation in rates of CTO use are not well understood. What does this paper add? This paper provides an empirical basis for a link between the politics of mental health and the uptake and usefulness of CTOs. What are the implications for practitioners? This paper makes explicit the real-world demands on the mental health system and how service deficiencies are a significant determinant in the use of CTOs. Practitioners and policy makers need to be candid about system limitations and how they factor in clinical and legal justifications for using involuntary treatment. The results of the present study provide data to support advocacy to improve policy accountability and resourcing of community mental health services.
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Kisely, Stephen R., Jianguo Xiao, and Neil J. Preston. "Impact of compulsory community treatment on admission rates." British Journal of Psychiatry 184, no. 5 (May 2004): 432–38. http://dx.doi.org/10.1192/bjp.184.5.432.
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BackgroundThere is controversy as to whether compulsory community treatment for psychiatric patients reduces hospital admission rates.AimsTo examine whether community treatment orders (CTOs) reduce admission rates, using a two-stage design of matching and multivariate analyses to take into account socio-demographic factors, clinical factors, case complexity and previous psychiatric and forensic history.MethodSurvival analysis of CTO cases and controls from three linked Western Australian databases of health service use, involuntary treatment and forensic history. We used two control groups: one matched on demographic characteristics, diagnosis, past psychiatric history and treatment setting, and consecutive controls matched on date of discharge from in-patient care.ResultsWe matched 265 CTO cases with 265 matched controls and 224 consecutive controls (totaln=754). The CTO group had a significantly higher readmission rate: 72%v.65% and 59% for the matched and consecutive controls (log-rank χ2=4.7,P=0.03). CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were associated with increased admission rates.ConclusionsCommunity treatment orders alone do not reduce admissions.
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Roman, Caterina G., and Nathan W. Link. "Community Reintegration Among Prisoners With Child Support Obligations: An Examination of Debt, Needs, and Service Receipt." Criminal Justice Policy Review 28, no. 9 (October 19, 2015): 896–917. http://dx.doi.org/10.1177/0887403415611460.
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In line with emerging work on the role of fatherhood in prisoner reentry, this study directs attention to the financial obligations that connect fathers to their families in reentry. Specifically, the study provides a descriptive picture of soon-to-be-released male state prisoners with child support obligations using a multi-state, longitudinal dataset, and examines whether characteristics of incarcerated men with child support orders and associated debt are significantly different from incarcerated males without child support orders. Whether males attached to comprehensive reentry programs received more services related to their debt obligation after prison release compared with non-program participants is also analyzed. Findings show that although prisoners identify having substantial needs vis-à-vis child support obligations, few reported receiving assistance related to these needs upon release. However, reentry program participants received significantly more child support–related services than non-program participants. Implications for community services and support for returning prisoners with child support orders and related needs are discussed.
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O'Brien, Wendy. "Youth Justice: Challenges in Responding to Young People Convicted of Sexual Offences." Deakin Law Review 16, no. 1 (August 1, 2011): 133. http://dx.doi.org/10.21153/dlr2011vol16no1art97.
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The clinical and criminological literature on adolescents who have committed sexual offences indicates that the pathologisation of young people and a labelling or overly punitive response is likely to be more harmful than rehabilitative. Accordingly, therapeutic counselling and diversionary schemes are seen as preferable to custodial terms in most instances. For adolescents convicted of sex offences, clinicians identify the benefits of comprehensive therapeutic care which involves family and is sensitive to the young person’s context and culture. The benefits of this approach are documented and, although data are limited, indications are that recidivism is reduced where adolescents are provided with specialised counselling to encourage positive and non-abusive behaviours. In Australia, each state and territory has provisions for youth justice clients serving custodial or community orders for sexually abusive behaviours. Yet each jurisdiction experiences challenges in ensuring the delivery of equitable and comprehensive therapeutic services, particularly to regionally and remotely located youth. This paper draws on data from a national study of the therapeutic services to children and adolescents with sexualised or sexual offending behaviours. With attention to the difficulties in providing services to regionally and remotely located adolescents, this paper highlights challenges around lengthy remand terms, the provision of pre-offence diversionary programs, and the provision of specialised supervision for young people serving community orders. For example, jurisdictions with the largest geographic service areas face enormous difficulties in providing specialised supervision for community-based orders. At present, there are several jurisdictions where regionally and remotely located adolescents may serve the duration of a youth justice order without receiving specialised counselling to assist them in modifying their behaviours. The paper identifies the risks where specialised counselling cannot be provided, but also identifies specific initiatives designed to fill these gaps in service provision to youth justice clients.
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Ugwudike, Pamela. "Understanding Compliance Dynamics in Community Justice Settings." International Criminal Justice Review 27, no. 1 (December 29, 2016): 40–59. http://dx.doi.org/10.1177/1057567716679231.
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This article seeks to expand the existing literature on compliance in community justice settings by highlighting the importance of service user participation in efforts to achieve compliance. The article’s central argument is that although co-productive strategies can enhance service user participation, the degree to which co-production is achievable in penal supervision is perhaps uncertain, and has received insufficient theoretical or empirical attention. To address the gap in knowledge, the article draws on the data generated from a study of compliance in Wales, United Kingdom, and employs the Bourdieusian concepts of habitus, field, and capital to argue that the convergence of two key factors undermines the viability of co-productive strategies in penal settings. One factor is the service users’ habitus of powerlessness which may breed passivity rather than active participation. The second also relates to the power dynamics that characterize penal supervision contexts. Within these contexts, practitioners are statutorily empowered to implement and enforce the requirements of community orders. In the current target-focused policy climate in England and Wales, practitioners may prioritize measurable compliance over forms of compliance that stem from service user participation and engagement perhaps because these are not readily quantifiable.
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Leight, Jessica, Catherine Hensly, Marcos Chissano, and Liza Ali. "Short-term effects of the COVID-19 state of emergency on contraceptive access and utilization in Mozambique." PLOS ONE 16, no. 3 (March 25, 2021): e0249195. http://dx.doi.org/10.1371/journal.pone.0249195.
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The COVID-19 pandemic has increasingly disrupted the global delivery of preventive health care services, as a large number of governments have issued state of emergency orders halting service delivery. However, there is limited evidence on the realized effects of the pandemic and associated emergency orders on access to services in low-income country contexts to date. To address this gap, this paper analyzes administrative data on utilization of contraceptive health services by women referred via community health promoters in two large urban and peri-urban areas of Mozambique. We focus on the period immediately surrounding the national state of emergency declaration linked to the COVID-19 pandemic on March 31, 2020. Data reported for 109,129 women served by 132 unique promoters and 192 unique public health facilities is analyzed using logistic regression, interrupted time series analysis and hazard analysis. The results demonstrate that the imposition of the state of emergency is associated with a modest short-term drop in both service provision and utilization, followed by a relatively rapid rebound. We conclude that in this context, the accessibility of reproductive health services was not dramatically reduced during the first phase of the pandemic-related emergency.
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Kisely, Steve, Katherine Moss, Melinda Boyd, and Dan Siskind. "Efficacy of compulsory community treatment and use in minority ethnic populations: A statewide cohort study." Australian & New Zealand Journal of Psychiatry 54, no. 1 (September 26, 2019): 76–88. http://dx.doi.org/10.1177/0004867419877690.
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Background: There is conflicting and equivocal evidence for the efficacy of compulsory community treatment within Australia and overseas, but no study from Queensland. In addition, although people from Indigenous or culturally and linguistically diverse backgrounds are over-represented in compulsory admissions to hospital, little is known about whether this also applies to compulsory community treatment. Aims: We initially investigated whether people from Indigenous or culturally and linguistically diverse backgrounds in terms of country of birth, or preferred language, were more likely to be on compulsory community treatment using statewide databases from Queensland. We then assessed the impact of compulsory community treatment on health service use over the following 12 months. Compulsory community treatment included both community treatment orders and forensic orders. Methods: Cases and controls from administrative health data were matched on age, sex, diagnosis and time of hospital discharge (the index date). Multivariate analyses were used to examine potential predictors of compulsory community treatment, as well as impact on bed-days, time to readmission or contacts with public mental health services in the subsequent year. Results: We identified 7432 cases and controls from January 2013 to February 2017 (total n = 14,864). Compulsory community treatment was more likely in Indigenous Queenslanders (adjusted odds ratio = 1.45; 95% confidence interval = [1.28, 1.65]) subjects coming from a culturally and linguistically diverse background (adjusted odds ratio = 1.54; 95% confidence interval = [1.37, 1.72]), or those who had a preferred language other than English (adjusted odds ratio = 1.66; 95% confidence interval = [1.30, 2.11]). While community contacts were significantly greater in patients on compulsory community treatment, there was no difference in bed-days while time to readmission was shorter. Restricting the analyses to just community treatment orders did not alter these results. Conclusion: In common with other coercive treatments, Indigenous Australians and people from culturally and linguistically diverse backgrounds are more likely to be placed on compulsory community treatment. The evidence for effectiveness remains inconclusive.
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Al-Uzri, Mohammed, Zena Harvey, Fabida Noushad, Chinyere Iheonu, and Mohammed Abbas. "Impact of community treatment orders on inpatient bed usage in assertive outreach team." BJPsych Open 7, S1 (June 2021): S233—S234. http://dx.doi.org/10.1192/bjo.2021.625.
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AimsTo examine the impact of using Communty Treatment Orders (CTO) of the Mental Health Act on use of inpatient care in Assertive Outreach team.BackgroundCurrently there is little evidence of the efficacy of community treatment orders (CTOs), and in particular with patients who use the Assertive Outreach service. One large randomised controlled study found no impact on use of inpatient care while a naturalistc study found significant impact.MethodOur primary outcome was the number of admissions with and without a CTO comparing each patient with themselves before CTO and under CTO(“mirror-image”). Our secondary outcomes were the number of bed days, and the percentage of missed community visits post-discharge. We also looked at the potential cost savings of a reduction in inpatient bed usage.ResultAll the 63 patients studied over period of 6 years had a severe and enduring mental illness. The use of a CTO was linked to a significant reduction in the number of admissions (mean difference = 0.89, 95% CI = 0.53–1.25, P < 0.0001) and bed days (mean difference = 158.65, 95% CI = 102.21–215.09, P < 0.0001) There was no significant difference in the percentage of missed community visits post-discharge. Looking at the costs, an average cost for an inpatient Assertive Outreach bed per day in the local Trust was £250, and there were 8145 bed days saved in total, making a potential saving of just over £2million, during the study period.ConclusionThis study suggests that the implementation of CTOs using clinical judgment and knowledge of patients can significantly reduce the bed usage of Assertive Outreach patients. The financial implications of CTOs need to be reviewed further, but this study does suggest that the implementation of CTOs is a cost-effective intervention and is economically advantageous to the local Trust.
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Denning, Rebecca, and Ross Homel. "Predicting Recidivism in Juvenile Offenders on Community-Based Orders: The Impact of Risk Factors and Service Delivery." Journal of Offender Rehabilitation 46, no. 3-4 (May 23, 2008): 189–215. http://dx.doi.org/10.1080/10509670802143508.
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卢, 铁荣. "社会服务令的争议与再定位." Hong Kong Journal of Social Work 37, no. 02 (January 2003): 207–19. http://dx.doi.org/10.1142/s0219246203000184.
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刑罚有不同的目的和作用，它们是：让罪犯补偿社会、复康、重投社会；使罪犯获得报应；阻吓他人；从社会移除害群之马，如监禁。前三者正是社会服务令的目的，它旨在协助罪犯补偿社会，从而改过自新和重投社会怀抱。而在谢霆锋案中，後三者却是很多社会人士所强烈要求的惩罚目的。为了避免日後再有类似的争论发生，社会服务令的重新定位是刻不容缓的。确立社会服务令为短期监禁的代替刑及订立清楚的换算方式，不但会减少争议，也能增加法庭的判刑选择，在扩大运用社区刑罚的同时，也能为上述各种惩罚目的找到更佳的平衡点，这将有助於我们迈向一个富有复和司法的社会。 Sentencing has various objectives and functions, including reparation, rehabilitation, reintegration, retribution, deterrence and removal from society, such as incarceration. Community service orders incorporate the first three functions. They assist offenders to make reparation to society for the crimes they have committed, to turn over a new leaf, and to reintegrate into society. In the case of singer Nicholas Tse, the last three functions were demanded by the community. To avoid similar conflicts in the future, to reposition community service orders is inevitable. There is an urgent need to reiterate community service orders as alternatives to imprisonment, and to establish a clear guideline for conversion between service hours and jail days. This approach would minimise conflicts in society, increase sentencing options and community penalties for the court, strike a balance between different penal goals, and strive for a restorative society.
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Trevithick, Liam, Jane Carlile, Sunil Nodiyal, and Patrick Keown. "Community treatment orders: an analysis of the first five years of use in England." British Journal of Psychiatry 212, no. 3 (February 14, 2018): 175–79. http://dx.doi.org/10.1192/bjp.2017.51.
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BackgroundCommunity treatment orders (CTOs) were introduced in England in 2008.AimsTo measure the rate of CTO use in England during the first 5 years following introduction.MethodThe number of involuntary detentions and CTOs in National Health Service (NHS) hospital trusts was collected between 2009 and 2014. Rates of CTO use and the ratio of CTOs to detentions on admission were calculated, and how these varied between trusts.ResultsThe number of new CTOs each year ranged between 3834 and 4647. The number subject to a CTO per 100 000 population increased from 6.4 in 2009/10 to 10.0 in 2013/14. There was variation between NHS trusts in the use of CTOs when compared with the number of involuntary detentionsConclusionsThe number of patients on CTOs increased year on year. Those on forensic sections were more likely to be discharged on a CTO than those on civil sections. There was considerable variation in the pattern of use between hospitals.Declaration of interestNone.
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Ruud, Torleif, and Svein Friis. "Community-based Mental Health Services in Norway." Consortium Psychiatricum 2, no. 1 (March 20, 2021): 47–54. http://dx.doi.org/10.17816/cp43.
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Community-based mental healthcare in Norway consists of local community mental health centres (CMHCs) collaborating with general practitioners and primary mental healthcare in the municipalities, and with psychiatrists and psychologists working in private practices. The CMHCs were developed from the 1980s to give a broad range of comprehensive mental health services in local catchment areas. The CMHCs have outpatient clinics, mobile teams, and inpatient wards. They serve the larger group of patients needing specialized mental healthcare, and they also collaborate with the hospital-based mental health services. Both CMHCs and hospitals are operated by 19 health trusts with public funding.
Increasing resources in community-based mental healthcare was a major aim in a national plan for mental health between 1999 and 2008. The number of beds has decreased in CMHCs the last decade, while there has been an increase in mobile teams including crisis resolution teams (CRTs), early intervention teams for psychosis and assertive community treatment teams (ACT teams). Team-based care for mental health problems is also part of primary care, including care for patients with severe mental illnesses. Involuntary inpatient admissions mainly take place at hospitals, but CMHCs may continue such admissions and give community treatment orders for involuntary treatment in the community.
The increasing specialization of mental health services are considered to have improved services. However, this may also have resulted in more fragmented services and less continuity of care from service providers whom the patients know and trust. This can be a particular problem for patients with severe mental illnesses. As the outcomes of routine mental health services are usually not measured, the effects of community-based mental care for the patients and their families, are mostly unknown.
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Roeger, L. S. "The Effectiveness of Criminal Justice Sanctions for Aboriginal Offenders*." Australian & New Zealand Journal of Criminology 27, no. 3 (December 1994): 264–81. http://dx.doi.org/10.1177/000486589402700304.
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This paper compares the recidivism rates of Aboriginal offenders sentenced to imprisonment with those placed on community based orders. This research was prompted by recommendations made by the Royal Commission into Aboriginal Deaths in Custody which called for an understanding of the effectiveness of non-custodial orders for Aboriginal offenders. The sample was comprised of male Aboriginal offenders placed on either probation or community service or released from custody after serving between 1 month and 2 years imprisonment. Overall 43% of the sample were sentenced to imprisonment during the follow-up period which was for 3½ years. Factors found to be associated with recidivism (defined as sentenced to imprisonment) were age, number of prior convictions, previous imprisonment, possession of a juvenile record and education level. After controlling for these factors using multivariate statistical procedures, no differences were found between the recidivism rates of those imprisoned and those placed on community based sanctions. The relationship between recidivism rates and diversion from custody is discussed.
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Rosmarin-DeStefano, Corey L., Eileen Scarinci, Diana Finkel, and Erika Escabi. "1543. Risk Reduction service delivery during the COVID Pandemic to a marginalized urban population in Newark, NJ." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S771. http://dx.doi.org/10.1093/ofid/ofaa439.1723.
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Abstract Background North Jersey Community Research Initiative (NJCRI) is a non- profit organization in Newark, NJ that provides medical care and support services for highly vulnerable and hard to reach patient populations (e.g. homeless, HIV/AIDS, transgender, MSM, injection drug users, sex workers), 83% of whom are people of color. We are in a unique position to identify critical vulnerabilities and continued risk factors in our communities and patients during pandemics especially identifying HIV, HCV and other STIs and providing support services to this population. Methods We assessed the impact of COVID on HIV, HCV, STI Clinical care, testing, prevention, treatment, mental health and substance abuse services and patent retention. We used our EMR data to track patient visits, prevention visits and testing pre and post covid. Post Covid we utilized Telemedicine and mobile units to continue to provide services as well as self collection kits for the patients for testing. We staggered schedules on site in our outdoor triage center for support services like syringe exchange and food pantry and made an outdoor triage center for all services. Our phone system was routed to providers who assessed provided medical care through telemedicine and remote lab orders and Medication orders were sent via EMR to pharmacies who delivered the medications. Results Pre Covid Jan-Feb 2020: 855 clinical visits including testing Behavioral visits 191. Syringe exchange 38,653 needles to 73 clients, Food 189 clients received food. LGBTQ service Clients Reached 779 Post Covid March 2020 333 clinical visits including testing behavioral visits 154 April 2020 360 clinical visits including testing behavioral visits 208 May 2020 447 clinical visits including testing behavioral visits 282 Syringe exchange March- May 27,367 needles to 53 clients Food received March-may 118 clients LGBTQ clients reached 2035 Conclusion Assess and implement best practices post COVID to plan for services in the event that we have another wave of COVID. STI, HIV and HCV services and testing can be successfully delivered remotely and through an outdoor triage facility in an underserved urban setting. Point of Service testing for both home and outdoor settings will be added to treatment paradigms to better serve the needs of the community. Disclosures All Authors: No reported disclosures
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Davis, Alana, Michael Doyle, Ethel Quayle, and Suzanne O'Rourke. "Am I there yet? The views of people with learning disability on forensic community rehabilitation." Journal of Intellectual Disabilities and Offending Behaviour 6, no. 3/4 (December 14, 2015): 148–64. http://dx.doi.org/10.1108/jidob-08-2015-0024.
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Purpose – Previously, diversion from the criminal justice system for people with learning disability (LD) and serious forensic needs in Scotland meant hospitalisation. More recently new legislation has meant that community-based rehabilitation is possible for this group. The purpose of this paper is to qualitatively explore the views of people with LD subject to these legal orders. This is both a chance to work in partnership to improve services and also to make the voices of this potentially vulnerable group heard. Design/methodology/approach – Semi-structured interviews were conducted with ten participants subject to a community-based order. All participants were male. Ages, index behaviour, and time spent on order varied. The data was transcribed and analysed using interpretative phenomenological analysis. Findings – The main themes which emerged from the data were a taste of freedom, not being in control, getting control back, loneliness, and feeling like a service user. Participants described positives about community-based rehabilitation but also a number of negatives. Practical implications – Participant accounts suggest that the current community rehabilitation model has some shortcomings which need to be addressed. Suggestions are made for improvements to the current model relating to: achieving clarity over the role of support staff and pathways out of the system; increasing opportunities for service users to voice concerns; empowering staff teams via extensive training and supervision; and directly addressing internalised stigma to promote community integration. Originality/value – This is the first piece of work evaluating compulsory community forensic care for people with LD from the perspective of service users. It highlights difficulties with the system which could lead to helpful ways to evolve this model.
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Kisely, Steve, Neil Preston, Jianguo Xiao, David Lawrence, Sandra Louise, Elizabeth Crowe, and Steven Segal. "An eleven-year evaluation of the effect of community treatment orders on changes in mental health service use." Journal of Psychiatric Research 47, no. 5 (May 2013): 650–56. http://dx.doi.org/10.1016/j.jpsychires.2013.01.010.
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MENZIES, KEN, and ANTONY A. VASS. "The Impact of Historical, Legal and Administrative Differences on a Sanction: Community Service Orders in England and Ontario." Howard Journal of Criminal Justice 28, no. 3 (August 1989): 204–17. http://dx.doi.org/10.1111/j.1468-2311.1989.tb00650.x.
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Kilen Stuen, H., R. Wynn, A. Landheim, and J. RugkÂsa. "EPA-0430 – Use of committed treatment orders in norwegian assertive community treatment (act) teams, seen from the service users‘perspective." European Psychiatry 29 (2014): 1. http://dx.doi.org/10.1016/s0924-9338(14)77852-6.
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McConachie, Sean, Dmitriy Martirosov, Bryan Wang, Neha Desai, Sabrina Jarjosa, and Lama Hsaiky. "Surviving the surge: Evaluation of early impact of COVID-19 on inpatient pharmacy services at a community teaching hospital." American Journal of Health-System Pharmacy 77, no. 23 (May 29, 2020): 1994–2002. http://dx.doi.org/10.1093/ajhp/zxaa189.
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Abstract Purpose The coronavirus disease 2019 (COVID-19) pandemic has presented novel challenges to healthcare systems; however, an analysis of the impact of the pandemic on inpatient pharmacy services has not yet been conducted. Methods Results of an observational assessment of operational and clinical pharmacy services at a community teaching hospital during the first weeks of the COVID-19 pandemic are presented. Service outcomes of the inpatient pharmacy were evaluated from February 1 to April 8, 2020. Outcomes during the weeks preceding the first COVID-19 admission (February 1 to March 11, 2020) and during the pandemic period (March 12 to April 8, 2020) were compared. Evaluated outcomes included daily order verifications, clinical interventions, and usage of relevant medications. An exploratory statistical analysis was conducted using Student’s t test. Results During the pandemic period, the number of new order verifications decreased from approximately 5,000 orders per day to 3,300 orders per day (P < 0.01), a reduction of 30% during the first 4 weeks of the pandemic compared to the weeks prior. Average daily pharmacokinetic dosing consults were reduced in the pandemic period (from 82 to 67; P < 0.01) compared to the prepandemic period; however, total daily pharmacist interventions did not differ significantly (473 vs 456; P = 0.68). Dispensing of hydroxychloroquine, azithromycin, enoxaparin, and sedative medications increased substantially during the pandemic period (P < 0.01 for all comparisons). Conclusion The operational and clinical requirements of an inpatient pharmacy department shifted considerably during the first weeks of the COVID-19 pandemic. Pharmacy departments must be adaptable in order to continue to provide effective pharmaceutical care during the pandemic.
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Long, Clive G., Olga Dolley, and Clive Hollin. "The use of the mental health treatment requirement (MHTR): clinical outcomes at one year of a collaboration." Journal of Criminal Psychology 8, no. 3 (August 6, 2018): 215–33. http://dx.doi.org/10.1108/jcp-01-2018-0003.
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Purpose In the UK, the mental health treatment requirement (MHTR) order for offenders on probation has been underused. A MHTR service was established to assess the effectiveness of a partnership between a probation service, a link worker charity and an independent mental healthcare provider. Short-term structured cognitive behavioural interventions were delivered by psychology graduates with relevant work experience and training. Training for the judiciary on the MHTR and the new service led to a significant increase in the use of MHTR orders. The paper aims to discuss these issues. Design/methodology/approach A total of 56 (of 76 MHTR offenders) completed treatment in the first 12 months. A single cohort pre-post follow-up design was used to evaluate change in the following domains: mental health and wellbeing; coping skills; social adjustment; and criminal justice outcomes. Mental health treatment interventions were delivered under supervision by two psychology graduates who had relevant work experience and who were trained in short term, structured, cognitive behavioural (CBT) interventions. Findings Clinically significant changes were obtained on measures of anxiety and depression, and on measures of social problem solving, emotional regulation and self-efficacy. Ratings of work and social adjustment and pre-post ratings of dynamic criminogenic risk factors also improved. This new initiative has addressed the moral argument for equality of access to mental health services for offenders given a community order. Originality/value While the current initiative represents one of a number of models designed to increase the collaboration between the criminal justice and the mental health systems, this is the first within the UK to deliver a therapeutic response at the point of sentencing for offenders with mental health problems. The significant increase in the provision of MHTR community orders in the first year of the project has been associated with a decrease in the number of psychiatric reports requested that are time consuming and do not lead to a rapid treatment.
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Kisely, Steve, and Katharine Hall. "An Updated Meta-Analysis of Randomized Controlled Evidence for the Effectiveness of Community Treatment Orders." Canadian Journal of Psychiatry 59, no. 10 (October 2014): 561–64. http://dx.doi.org/10.1177/070674371405901010.
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Objectives: It is unclear whether community treatment orders (CTOs) for people with severe mental illnesses can reduce health service use, or improve clinical and social outcomes. Randomized controlled trials of CTOs are rare because of ethical and logistical concerns. This meta-analysis updates available evidence. Method: A systematic literature search was performed of the Cochrane Schizophrenia Group Register, Science Citation Index, PubMed, MEDLINE, and Embase to November 2013. Inclusion criteria were studies comparing CTOs with standard care including those where control subjects received voluntary care, for most of the trial. Results: Three studies provided 749 subjects for the meta-analysis. Two compared compulsory treatment with entirely voluntary care, while the third had control subjects receiving voluntary treatment for the bulk of the time. Compared with control subjects, CTOs did not reduce readmissions (risk ratio 0.98, 95% CI 0.82 to 1.16) or bed days (mean difference [MD] −16.36; 95% CI −40.8 to 8.05) in the subsequent 12 months ( n = 749). Moreover, there were no significant differences in psychiatric symptoms (standardized MD −0.03; 95% CI −0.25 to 0.19; n = 331) or the Global Assessment of Functioning (MD −1.36; 95% CI −4.07 to 1.35; n = 335). Only including the 2 studies that compared compulsory treatment with entirely voluntary care made no difference to the results. Conclusions: CTOs may not lead to significant differences in readmission, social functioning, or symptomatology, compared with standard care. Their use should be kept under review.
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Evans, Rob, Jayaprakash Makala, Martin Humphreys, and Chitra R. N. Mohan. "Supervised community treatment in Birmingham and Solihull: first 6 months." Psychiatrist 34, no. 8 (August 2010): 330–33. http://dx.doi.org/10.1192/pb.bp.109.027482.
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Aims and methodTo describe the first 6 months of the newly introduced community treatment orders (CTOs) in Birmingham and Solihull mental health services; to establish a clearer picture of patterns of use and some early outcomes. Computerised note systems were used to collect a range of sociodemographic and clinical data using a specially designed data collection tool.ResultsWe observed higher than expected numbers of CTOs compared with previous use of Section 25 supervised discharge. Our results were consistent with international studies in showing that CTOs are typically used in males aged around 40 with a primary diagnosis of psychotic illness. Compared with the census population, Black and minority ethnic groups were overrepresented in our sample. There were high recorded rates of comorbid alcohol or substance misuse and violence. The majority of patients on CTOs were being followed up by community mental health teams or assertive outreach teams.Clinical implicationsIt is difficult to draw firm conclusions at this early stage of implementation. However, there are likely to be resource implications in view of the high numbers of CTOs applied compared with Section 25 discharge. Service providers, clinicians and commissioners need to ensure CTOs are backed up by high-quality care. Further research is required into the impact of CTOs on a range of outcomes and to understand differential rates of CTO across different ethnic groups.
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Rauhaus, Beth M., Deborah Sibila, and Andrew F. Johnson. "Addressing the Increase of Domestic Violence and Abuse During the COVID-19 Pandemic: A Need for Empathy, Care, and Social Equity in Collaborative Planning and Responses." American Review of Public Administration 50, no. 6-7 (July 13, 2020): 668–74. http://dx.doi.org/10.1177/0275074020942079.
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During COVID-19, stay at home orders have led to the rise of domestic violence and abuse claims in many localities globally, leaving community leaders unprepared to address the increase of domestic violence incidences. As local public officials are becoming concerned about the increase of domestic violence and in some instances, the decrease due to the inability of victims to report instances, a collaborative response is necessary. This work examines how social equity and public service values, such as compassion, empathy, and an ethic of care, may be incorporated into collaborative planning and responses to domestic violence plaguing communities during the pandemic. Recommendations for raising awareness, incorporating social equity in public service, and collaborative reporting are made.
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GOLDEN, CHRISTOPHER D., A. CLARE GUPTA, BAPU VAITLA, and SAMUEL S. MYERS. "Ecosystem services and food security: assessing inequality at community, household and individual scales." Environmental Conservation 43, no. 4 (June 10, 2016): 381–88. http://dx.doi.org/10.1017/s0376892916000163.
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SUMMARYWildlife populations provide harvestable meat to people and contribute to local food security. Throughout the year, and particularly at times of agricultural food shortages, wildlife and other wild foods play a critical role in supporting food security and enhancing local human nutrition. We explored the distribution of food security benefits of agricultural food production and a particular ecosystem provisioning service – wildlife harvest in the Makira Natural Park (MNP) of Madagascar – at community, household and individual levels. We found strong variation in wildlife consumption both among communities and among households and less variation among individuals within households. Mean household wildlife consumption in the target community was 10 kg per year ranging by approximately two orders of magnitude, with poorer and more food insecure households more reliant on wildlife for food. Meats (including wildlife) appeared to be evenly distributed within households, unaffected by age, sex, birth order and body weight, while other foods (including stew, rice and other staples) appeared to be allocated based on body mass. Reductions in wildlife consumption cause increased risk of food insecurity and specific nutritional deficiencies. The findings from our multilevel study suggest that disaggregated analysis that merges ecosystem services theory and the microeconomics of resource allocation allows for a more accurate valuation approach.
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Merész, Gergő, and Bence Takács. "PP165 Content Instead Of Orders: Experiences Of Launching A Knowledge Base." International Journal of Technology Assessment in Health Care 35, S1 (2019): 68. http://dx.doi.org/10.1017/s0266462319002642.
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IntroductionIn Hungary, the procedure for health technology assessment of innovative pharmaceutical products allows 13 assessors 43 calendar days to evaluate reimbursement submissions. These short timelines have created a need for smart capacity building, namely, streamlining the scientific evaluation process while making sure that the quality of the critical appraisals remain high. The objective of this study was to present and evaluate the implementation of an online knowledge base to distill community knowledge, and also for management purposes.MethodsThe scope and the content-, functional-, and technical specification was developed, and information technology security requirements were identified during the pre-implementation phase. An existing platform was chosen for adaptation, ensuring that descriptive follow-up data is available on uptake for monitoring purposes. Both the adaptation and maintenance were carried out internally by the Department of Health Technology Assessment at the National Institute of Pharmacy and Nutrition.ResultsThe key requirements identified when developing the specification were searchability, low maintenance need, low operating costs and attractivity for users. An already existing open-source, flat file content management system was chosen for adaptation. In terms of content, a health technology assessment handbook, process documentation, a news bulletin section was created, and corporate identity elements were added. Since the start of the service in September 2018, the number of total daily page downloads to the knowledge base varied between four and 1,193 (average 205 per day), with the assessment handbook topping the overall page visit statistics.ConclusionsThe implementation of this knowledge base enables the Department of Technology Assessment to rely more on the formalized community knowledge when carrying out critical appraisal, while enabling better knowledge and quality management. Uptake remains an issue on the long run, indicating a need for continuous content development.
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Macdonald, Kerry, Andrew Robert, Breanne Bannerman-Gobeil, Richard Bee, Alan Chorney, Caralie Heinrichs, Stacey Lee, Kelly Murray, and Melanie Sucha. "Manitoba Public Libraries Response to the Early Stages of COVID-19." Partnership: The Canadian Journal of Library and Information Practice and Research 16, no. 1 (July 9, 2021): 1–11. http://dx.doi.org/10.21083/partnership.v16i1.6473.
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Like many libraries across Canada, Manitoba public libraries have grappled with the challenges that COVID-19 has presented. Libraries have struggled to remain operational and offer a high level of service to patrons within the constraint of public health orders, all the while ensuring the safety and employment of their staff. Within the ever-changing environment of COVID-19, the Manitoba Library Association recognized the need to gather information from the library community in order to better position themselves to lend support and in an attempt to bridge information gaps. This article describes a study conducted by the Manitoba Library Association whereby fifty-five Manitoba public libraries were surveyed to identify how they were responding to COVID-19 and what their needs might be. The survey questions were divided into 6 sections (facilities, services, communications, staffing, connecting, wrap-up) and the results provide information and insight into how the Manitoba library community has dealt with the pandemic. More importantly, the results can serve to guide other libraries in decision-making and preparation for a pandemic.
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KISELY, STEPHEN, MARK SMITH, NEIL J. PRESTON, and JIANGUO XIAO. "A comparison of health service use in two jurisdictions with and without compulsory community treatment." Psychological Medicine 35, no. 9 (September 2005): 1357–67. http://dx.doi.org/10.1017/s0033291705004824.
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Background. This study examines whether community treatment orders (CTOs) reduce psychiatric admission rates or bed-days for patients from Western Australia compared to control patients from a jurisdiction without this legislation (Nova Scotia).Method. A population-based record linkage analysis of an inception cohort using a two-stage design of matching and multivariate analyses to control for sociodemographics, clinical features and psychiatric history. All discharges from in-patient psychiatric services in Western Australia and Nova Scotia were included covering a population of 2·6 million people. Patients on CTOs in the first year of implementation in Western Australia were compared with controls from Nova Scotia matched on date of discharge from in-patient care, demographics, diagnosis and past in-patient psychiatric history. We analysed time to admission using Cox regression analyses and number of bed-days using logistic regression.Results. We matched 196 CTO cases with an equal number of controls. On survival analyses, CTO cases had a significantly greater readmission rate. Co-morbid personality disorder and previous psychiatric history were also associated with readmission. However, on logistic regression, patients on CTOs spent less time in hospital in the following year, with reduced in-patient stays of over 100 days.Conclusions. Although compulsory community treatment does not reduce hospital admission rates, increased surveillance of patients on CTOs may lead to earlier intervention such as admission, so reducing length of hospital stay. However, we do not know if it is the intensity of treatment, or its compulsory nature, that effects outcome.
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Muirhead, David, Carol Harvey, and Graham Ingram. "Effectiveness of Community Treatment Orders for Treatment of Schizophrenia with Oral or Depot Antipsychotic Medication: Clinical Outcomes." Australian & New Zealand Journal of Psychiatry 40, no. 6-7 (June 2006): 596–605. http://dx.doi.org/10.1080/j.1440-1614.2006.01844.x.
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Objective: This study examined the effectiveness of community treatment orders (CTOs) used in the treatment of patients with schizophrenia. The hypotheses were that CTOs enhance outcome for patients whose mental health would otherwise be compromised by poor adherence with treatment and that CTOs would enable this when either oral or depot antipsychotic medication was prescribed. Method: This was a naturalistic study using a retrospective mirror-image design. The sample consisted of patients with schizophrenia (n = 94) who were treated on a CTO between November 1996 and October 1999. Two subgroups were defined: patients treated with oral antipsychotic medication (n = 31), and patients treated with depot medication (n = 63). Data were gathered via file review using a questionnaire. Results: For the whole sample and both subgroups the findings included significant increased number of service contacts, decreased number of admissions and decreased length of inpatient stay. For the total sample numbers of crisis team referrals and other episodes of relapse were significantly decreased. For the subgroup on depot medication there was a non-significant trend towards fewer crisis team referrals and a significant decrease in other episodes of relapse. There were no significant differences for the oral subgroup in crisis team referrals or other episodes of relapse. Conclusions: This study provides further evidence that CTOs may be effective in improving the outcome for selected persons with schizophrenia and some evidence that they may enhance the outcome for selected patients with schizophrenia on oral antipsychotic medication.
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Febres-Cordero, Sarah, Athena D. F. Sherman, Joseph Karg, Ursula Kelly, Lisa M. Thompson, and Kylie Smith. "Designing a Graphic Novel: Engaging Community, Arts, and Culture Into Public Health Initiatives." Health Promotion Practice 22, no. 1_suppl (May 2021): 35S—43S. http://dx.doi.org/10.1177/1524839921996405.
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The opioid epidemic was declared a national public health emergency in 2017. In Georgia, standing orders for the opioid antagonist, naloxone, have been implemented to reduce mortality from opioid overdoses. Service industry workers in the Atlanta, Georgia, inner-city community of Little Five Points (L5P) have access to naloxone, potentially expanding overdose rescue efforts in the community setting. To explore the issues facing L5P, our research brings together qualitative descriptive inquiry, ethnography, community-based research, a community advisory board, and a local artist to maximize community dissemination of research findings through a graphic novel that describes encountering an opioid overdose. This format was chosen due to the ethical responsibility to disseminate in participants’ language and for its potential to empower and educate readers. This article describes the process of working on this study with the community and a local artist to create sample pages that will be tested for clarity of the message in a later phase. Working with an artist has revealed that while dissemination and implementation for collaboration begin before findings are ready, cross-collaboration with the artist requires early engagement, substantial funding, artist education in appropriate content, and member checking to establish community acceptability altering illustrations that reinforce negative stereotypes. By sharing the experiences of actions taken during an opioid overdose in L5P through a graphic novel, we can validate service industry workers’ experiences, acknowledge their efforts to contribute to harm reduction, and provide much-needed closure to those who encounter opioid overdoses in the community.
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Nwachukwu, Izu, Niall Crumlish, Elizabeth A. Heron, and Michael Gill. "Irish Mental Health Act 2001: impact on involuntary admissions in a community mental health service in Dublin." Psychiatrist 34, no. 10 (October 2010): 436–40. http://dx.doi.org/10.1192/pb.bp.109.028043.
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Aims and methodOn 1 November 2006, Ireland's Mental Health Act 2001 was implemented, replacing the country's Mental Treatment Act 1945. We aimed to assess the impact of this change in legislation on the number and duration of involuntary admissions. We undertook a retrospective review of all admissions to a psychiatric admissions unit from January to October 2006 (pre-implementation) and January to October 2007 (post-implementation).ResultsThere were 46 involuntary admissions in the 10-month period under study in 2006, or 33.8 per 100 000 population. There were 53 in 2007, or 39.3 per 100 000 population. This increase was not significant (z = – 0.7, P = 0.46), however involuntary admissions formed a larger proportion of all admissions under the Mental Health Act 2001 than under the Mental Treatment Act 1945 (χ2 = 4.2, P =0.04). There was no difference in the duration of involuntary admissions but under the 2001 Act, involuntary patients had longer periods of voluntary status as part of their admissions than under the 1945 Act.Clinical implicationsThe introduction of more rigorous procedures for involuntary admission did not significantly change the rate or duration of involuntary admissions in our centre. The finding that involuntary admissions included longer periods of voluntary status suggests that more care is being taken to revoke involuntary admission orders under the Mental Health Act 2001 than under the Mental Treatment Act 1945.
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Tonry, Michael. "Parochialism in U.S. Sentencing Policy." Crime & Delinquency 45, no. 1 (January 1999): 48–65. http://dx.doi.org/10.1177/0011128799045001003.
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The import/export trade in sentencing and corrections innovations between the United States and Europe is unbalanced. Humane, cost-effective sanctions such as prosecutorial fines, community service orders, and day fines have proliferated across national boundaries in Europe, but U.S. borders have proved impermeable. By contrast, American symbolic policies and rhetoric (e.g., three strikes, boot camps, truth in sentencing) have been adopted in mild forms in some English-speaking countries, but other European countries have shown no interest. The European focus on effectiveness, moderation, and humanity results in large part from constitutional arrangements that insulate sentencing and corrections policies from partisan and populist politics.
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Sudrajat, Jajat, and Meiryani Meiryani. "ONLINE MARKETING PARTNERSHIP APPLICATION USING THE CONCEPT OF BUSINESS MODEL CANVAS." ICCD 1, no. 1 (December 20, 2018): 496–500. http://dx.doi.org/10.33068/iccd.vol1.iss1.73.
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The purpose of implementing the long-term Community Service Program in the program is to produce a partnership model with Online Marketing Partnership Application using the concept of Business Model Canvas. This strategy is conducted to build partnerships with related parties that can increase success in the sector of Small and Medium Enterprises Silver Crafts by implementing strategies through online marketing of products. This Online Marketing Partnership application aims to accelerate the development of silver craftsmen in the village so as to increase sales. The method to be used is fact finding, in addition to collecting data in literature, also conducting interviews to Silver Craftsman owners and survey of business processes in order to collect supporting data. The output of this research is the Application of Online Marketing Partnership, one of which is a dynamic website that can be managed by Silver Craft Partners as a means of product promotion, besides through the website development of Silver Crafts Partners can receive orders from customers. Successful orders and transactions will be directly recorded through the sales transaction application.
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Khan, Omar Phoenix. "Introducing a gender-sensitive approach to pre-trial assessment and probation." Probation Journal 65, no. 2 (April 29, 2018): 184–200. http://dx.doi.org/10.1177/0264550518771167.
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This paper evaluates a pioneering project to introduce a gender-sensitive approach to working with women completing probation and community service orders in Kenya. The intervention consisted of context-specific research with women throughout Kenya, leading to adaptations to existing probation tools, followed by pilot implementation of a gender-sensitive approach. The evaluation explores the relevance, effectiveness and sustainability of the intervention and presents opinions of implementing probation officers and sector experts. Findings suggest that the project genuinely broke new ground in terms of research on gender-sensitivity and quality of pre-trial reporting for women. Close adherence to the UN Bangkok Rules means the model and lessons are applicable both domestically and globally.