Addressing risk factors for criminal legal involvement in treatment: The effects of training on state hospital clinicians’ knowledge and attitudes
Faith Scanlon PhD (1,2), Quinn Lewis BA (1,2,3), Isabella Monroe BS (1,2), Corinne Cather, PhD (1,2)
1. Massachusetts General Hospital
2. Harvard Medical School
3. Tufts University
Background: Estimates suggest that 9 to 25% of people experiencing early psychosis in the U.S. are involved in the criminal legal system (Rolin et al., 2019; Webster et al., 2024). For people with first episode psychosis (FEP), past criminal legal involvement (CLI) is predictive of future CLI (e.g., Scanlon et al., 2025) which is associated with a range of poorer outcomes including unstable housing and employment, mental illness, substance use, and suicide. It is therefore critical for clinicians working with the FEP population to have the knowledge and skills necessary to provide interventions targeting risk factors for CLI.
Methods: We delivered an 8-hour, one-day live training to 23 clinicians at Worcester Recovery Center and Hospital on a 9-session cognitive behavioral therapy-based intervention (Changing Lives and Changing Outcomes-9; CLCO-9). CLCO-9 was created for people with serious mental illness and CLI with the goal of improving illness self-management and risk factors for CLI (e.g., substance use, thoughts conducive to crime). Before and after the training, we administered self-report measures on clinicians’ knowledge of risk factors and best practices for treatment, as well as attitudes on the importance of addressing patients’ risk factors for CLI (N = 15).
Results: Paired samples t-tests showed clinicians’ knowledge of risk factors significantly increased from before to after completing the training, with a medium to large effect size (t[14] = 2.98, p = .01, d = 0.77). Similarly, clinicians’ ratings of the importance of addressing risk factors for legal involvement also significantly increased from pre- to post-training with a large effect (t[14] = 4.94, p < .001, d = 1.28).
Conclusions: Findings provide preliminary evidence that completing a training on a treatment program that targets risk factors for CLI helps clinicians develop skills to decrease the likelihood of future legal involvement and hospitalization for their patients.