Implementing Reform: Approaches to Alter the Use of Local Jail for People with Behavioral Health Conditions

To reduce the overrepresentation of people with behavioral health conditions in jails, jurisdictions have implemented evidence-based programs/policies (EBPPs) and treatments (EBTs). Using survey data from 519 U.S. counties, the present study classifies and evaluates the impact of strategies used to implement EBPPs and EBTs. Exploratory factor analysis identified four implementation approaches (i.e., clusters of strategies) which counties utilize to different extents depending on their population size: Relationship-Building among agencies (α = .911), infrastructural Capacity-Building (.788), developing Quality Programming (.880), and establishing Shared Definitions of key terms (.913). Relationship-Building and Shared Definitions were significant predictors of increased county-level availability of EBPPs and EBTs. These findings indicate that approaches focusing on interagency collaboration appear especially impactful. However, strategies that require more resources (viz. Capacity-Building) are underutilized. For smaller and/or rural counties with limited resources, an initial emphasis on interagency collaboration approaches can yield positive outcomes, as these require less initial investment and appear especially versatile.