Running head: DNP PROJECT FINAL REPORT

Mental Health Training for Correctional Officers

Ramses U. Vargas
Edson College of Nursing and Health Innovation
Arizona State University

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Abstract
Purpose & Background: Serious mental illness among incarcerated people continues to rise
within the United States. Correctional officers only receive an average of 13.54 hours of training
in special populations, including the mentally ill (Kois et al., 2020). This lack of training leaves
new correctional officers inadequately prepared to manage this population in prison. Education is
a cost-effective modality to provide a long-term change of practice. Mental health education was
provided to New Correctional Officers (NCOs) at a 2,000-bed facility in Southwestern United
States during their initial correctional officer training. Internal permissions were granted by the
prison internal review board (IRB) and the Arizona State University IRB.
Methods:NCOs (n = 7) were recruited and consented to participate in psychoeducation specific
to mentally ill prisoners. Using an evidence-based curriculum developed by Dr. Dana Dehart at
the University of South Carolina, NCOs participated in four (4) 1-hour long mental health
trainings that were instructor led. Pre/Post assessment tools were completed using a 10-item
trauma quiz and a 12- item Mental Health Knowledge Schedule (MAKS) scale assessing
participant attitudes towards mental illness.
Results: Participants were primarily male (57 %), White (42%), with an average age range
between 31-40 years old, and with a high school degree. Post intervention quiz and MAKS show
improved knowledge for all subjects using both tools.
Discussion/Conclusion: This project highlights cost-effective training with significant
preliminary results in reducing stigma towards the mentally ill in prison. Furthermore, this
information justifies the support, development, and funding for increasing mental health training
for correctional staff nationwide.
Keywords: mental health in prison, correctional officer, mental health stigma, mental health

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Mental Health Training for Correctional Officers
The current state of mental health disparities in the United States prison population has
dramatically risen over the last two decades. The rising incarceration rates have seen a steady
increase in the previous 50 years and have grown to house 2.23 million people in prison and jail
populations (Torrey et al., 2014). Consequently, the job requirements and scope of the
correctional officers who manage this challenging population have also significantly changed to
meet the rising demand. Correctional officers play a unique role in the life of prisoners, not only
by offering safety and security but also by collaborating with all disciplines involved in a
prisoner's daily life. The prison environment negatively exacerbates the mental health symptoms
of those with previously diagnosed mental illnesses (McNeeley & Donley, 2021). It also
dramatically impacts the mental health of stable individuals with no prior mental health history.
Prisoners with mental illnesses are perceived as challenging and dangerous and pose a high risk
of injury to correctional officers. Providing practical mental health training and psychoeducation
for correctional staff can be a critical component of the overall treatment plan of inmates and
greatly assist in reducing recidivism rates across the country.
Problem Statement
Today's correctional facilities continue to lack the ability to serve the dual purpose of a
safe prison and a therapeutic, rehabilitative environment for prisoners. According to Torrey et al.
(2014), in 44 out of 50 states, prisons or jails hold more individuals with serious mental illness
than the most prominent remaining state psychiatric hospital. At the center of this complex issue
are the correctional officers who engage daily with the mental health population and impact their
environment significantly. The influx of inmates with mental health illnesses is overwhelming to
the untrained correctional officers who receive minimal preparation to understand, interact, and

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manage this population. The adverse outcomes negatively impact the prisoner population and the
correctional staff members tasked with enforcing rules and regulations and can lead to high-risk
incidents that can cause injury to prisoners and correctional staff (McNeeley & Donley, 2021).
Compared to police officers in the community, correctional officers are at least three
times more likely to encounter people with a severe mental illness (Torrey et al., 2014).
Nevertheless, there continues to be a lack of formalized training for correctional officers to deal
effectively and appropriately with this population (Torrey et al., 2014). The correctional officers
who initially accept these positions expect that they will be enforcing law and order within the
confines of a prison. However, many are untrained or unequipped to deal with mentally ill
individuals who have mental illnesses. The consequences of having unqualified correctional staff
deal with special populations such as mentally ill inmates can have serious adverse effects if not
addressed. A collaborative approach between our current justice system, mental health agencies,
and congressional authorities is necessary to make meaningful long-term change in the area of
prison mental health.
The misuse of force against prisoners with mental illness speaks to a complex issue
within the prison system. The lack of training, supervision, and poor reporting leads to the
misuse of physical and chemical force on the mentally ill. Correctional officers' perceptions of
inmates with mental illness can be stigmatizing and inaccurate. This lack of education can lead to
biased behaviors and incorrect interpretations of events and behaviors. Correctional officers are
the front-line staff who frequently are the first to observe escalation of symptoms and changes in
behavior. Current prisoner victimization estimates vary from 5.8 to 21% of inmates experiencing
physical assault during the first 6 to 12 months in custody (Teasdale et al., 2016).
Background and Significance

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The Health Maintenance Organization (H.M.O.) act of 1973, whose goal was to balance
healthcare delivery against cost, introduced managed mental health care systems (Deleon et al.,
1991). The consequences of this act changed the delivery of mental health care and decreased
accessibility to mental health services. Organizations that wanted to receive federal funds would
need to provide a comprehensive set of eight essential services, including outpatient mental
health care and crisis intervention services (Deleon et al., 1991). Consequently, subsidizing the
creation and expansion of H.M.O.s, the 1973 H.M.O. Act also allowed the inclusion of profitmaking corporations as part of the health care program (Deleon et al., 1991). During the 1960s,
70s, and 80s, there was a period when mentally ill individuals were released from mental health
asylums, state hospitals, and other mental health institutions into community-based mental health
care systems (Deleon et al., 1991).
This shift impacted state and local communities in an unprecedented way by shifting
psychiatric care from state-run mental health hospitals to community outpatient clinics. One
example of the impact of this law passed in Arizona, where the Arizona State Hospital saw a
significant shift in mental health care delivery. In 1970, The Arizona Legislature passed Senate
Bill 1057 (A.R.S. 3655), requiring that patients be dangerous to themselves or others to be
admitted to the Arizona State Hospital. Due to this and other restrictions placed on admissions,
the hospital patient census dropped from around 2,000 to 300 patients (Arizona Department of
Health Services, 2022). Community mental health programs were unable to meet the increased
need. Over twenty million Americans are currently or have been incarcerated, the highest rate
globally. In the United States in 2013, there were approximately 2.3 million people incarcerated
in prisons and jails, or one in every 110 adults (Glaze & Kaeble, 2014). The community was
unable to cope with the increase of mentally ill persons. It caused arrest rates among offenders

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with serious mental illness to be higher than offenders' arrest rates in general (Abracen et al.,
2016). Mentally ill inmates are overrepresented in correctional settings at four times the general
population (Glaze & Kaeble, 2014). The rise in sick mentally ill being incarcerated has led to
prisons and jails housing more mentally ill persons than the mental health state hospitals (Allison
et al., 2018).
Major National Incentives
A national executive order that positively impacted incarcerated jail and prison
populations was enacted during President Barrack Obama's term. On December 18, 2014, an
Executive Order establishing a Presidential Task Force for 21st Century Policing was created to
be advisory solely. It required a report to be submitted the President by March 2, 2015 (U.S.
Department of Justice, 2015). The task force made several recommendations to police
departments and correctional facilities. They also published best practices for police departments
and correctional facilities. Three significant recommendations should be noted from this report.
The first was a review of commutations that modeled the Fair Sentencing Act of 2010. This
approach reviewed current prison sentences, specifically identifying non-violent crimes and
releasing offenders (U. S. Department of Justice, 2015). Another significant impact was the
elimination of federal prison contracts with private correctional facilities. This resulted in a
substantial shift in the private prison industry. In 2016, the Obama administration decided to
phase out the federal government's use of private prisons (Yates, 2016). The Department of
Justice concluded that private prisons failed to maintain the same level of rehabilitation, safety,
and security compared to public prisons. Also, cost savings were not substantial. Recently, the
Trump administration has recanted the Obama administration's decision (Sessions, 2017).

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Lastly and most importantly specific to mental illness in prison was a recommendation
from the Task Force to reduce or eliminate solitary confinement in prison. This resulted in a
directive from president Barrack Obama explicitly calling out the overuse of solitary
confinement. In 2015 President Obama implemented reforms to include banning solitary
confinement for juveniles, prohibiting its use as a response to low-level infractions, expanding
treatment of those with mental illness, increasing the number of time inmates spend out of their
cells and ensuring inmates are not released into communities directly from solitary confinement
(National Archives and Records Administration, 2019). The report sets out more than 50 guiding
principles, which cover a range of essential reform areas, including the use of the restrictive
housing as a form of punishment, the appropriate conditions of confinement in restrictive
housing, and the proper treatment of vulnerable inmate populations, such as juveniles, pregnant
women, LGBTI inmates, and inmates with serious mental illness (National Archives and
Records Administration, 2019).
Access to care continues to be a struggle for many Americans, especially for vulnerable
populations such as those who are mentally ill. Stigma can be a barrier for individuals who
experience psychiatric illness by making them hesitant to help-seek due to the fear of being
labeled and discriminated against (Kular et al., 2019). The lack of access to mental health
services available in the community, increases the risk of reincarceration. The challenge that
communities face appears to be a revolving door for inmates and populations at higher risk of
committing crimes, such as the mentally ill.
Without changing the outpatient community care paradigm, access to care and lack of
mental health services leading to increased recidivism rates will continue to be an issue that local
communities will have to manage. Limited access to community mental health services

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unfavorably impacts released inmates and exacerbates symptoms that lead to criminal activity.
Recently released prisoners have several immediate challenges when released to the community
that increases the likelihood of re-arrest. The two most challenging obstacles are obtaining
employment and securing safe, permanent housing. Without those two key collateral pieces, it is
difficult for them not to fall back into a life of crime and drug use that leads to incarceration. The
most troubling correlation is the increased successful suicide rate and the increased recidivism
rate that continues to burden society (Kaufman et al., 2020).
Large-scale recidivism studies have shown significantly higher re-arrest, re-conviction,
and reincarceration rates among released inmates with psychiatric disorders than their
counterparts without a psychiatric diagnosis (Brown, 2020). Besides, the impact of the
Affordable Care Act and the direct correlation between the cost of insurance and services has
also negatively impacted mental health services in the community (Kaufman et al., 2020). Public
insurance typically has more generous benefits than private insurance for people with mental
health problems. Those with mental disorders have substantial out-of-pocket expenditures for
medical care, accounting for about 29 percent of mental health and substance abuse outpatient
costs nationally (Galbraith et al., 2011).
Purpose and Rationale
The primary concern regarding correctional officer training is the lack of it. Training for
correctional officers is comprehensive in many aspects, including a physical, physiological, and
intense lecture on policy and procedure followed by a short on-the-job orientation. This
expedited process fills vacancies and gets correctional officers to staff shortages. Correctional
staff are not equipped to handle the behaviors of mental illness and highlight the inadequate
community resources that contribute to incarcerated persons cycling in and out of jails. More

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recently, research has suggested that correctional officers' experience of adversity in prisons
exceeds that of many community occupations and is equivalent to those in other high-risk
professions (Trounson et al., 2016). Although community law enforcement fares better,
probation and parole officer vacancy rates have been reported as high as 20%, and in some state
prisons, annual correctional officer turnover rates are as high as 55%; this constantly tests the
system's essential functionality (Trounson et al., 2016). The significance of low retention rates
for correctional officers in prisons, jails, and detention centers adversely impacts the prison
workforce. Low retention rates are a significant issue due to the continued entry of uneducated
staff, critical for the high vacancy rates previously mentioned (Suliman et al., 2018). An
examination among 300 correctional officers’ identified key protective factors to burnout
resilience. Results showed hope, optimism, and social support are significantly associated with
reduced burnout, and that this relationship is mediated by resilience. These results suggest that
personal strengths can reduce burnout in correctional officers by increasing resilience (Klinoff et
al., 2018).
Currently, strategies such as Justice and Mental Health Collaborative Program (JMHCP)
and (Smart De-incarceration) are desirable to increase educational requirements for jails and
prisons. Immediate resources are needed to train correctional officers within existing facilities to
support appropriate mental illness and trauma responses among incarcerated persons (DeHart
and Iachini, 2019). The concern of access to care for mentally ill inmates in the community is the
last piece of this puzzle that needs attention. Prisoners are expected to rehabilitate while in prison
and be ready to re-establish themselves in the community upon release. However, due to the lack
of services within the prison and lack of rehabilitation, released prisoners are at high risk of
returning. Furthermore, those inmates with mental illness have difficulties establishing essential

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services in the community, such as obtaining healthcare insurance and prescribed medications.
Skeem et al., 2011, conducted a study based on 44, 987 offenders and found that parolees with
mental illness (52–62%) were about two times more likely than parolees without illness to return
to prison within one year of release (30%). The mentally ill are not receiving critical mental
healthcare inside and outside the prison system.
Internal Evidence
The goal of jail authorities is to ensure the security and safety of staff and offenders while
providing a safe and rehabilitative environment. However, the correctional staff is increasingly
responsible for providing rehabilitation and treatment-type services to offenders, simultaneously
serving punitive, protective, and rehabilitative functions (Dvoskin & Spiers, 2004). Caring for
mentally ill prisoners who have severe mental illness has been a challenge for a society that has
not changed much. Advocacy groups have led to the decriminalization of the mentally ill, but not
much has changed in public opinion and correctional facility care. In 2015, Mental Health
America released a position statement underscoring the necessity of vigorously defending
prisoners' rights with mental health conditions; the statement included a call to action and
specifically stated the need for staff training on the mental health of prisoners (Mental Health
America, 2015). Furthermore, prisoners may become stigmatized and victimized due to mental
illness and may also be vulnerable to bullying, exclusion, and victimization by others.
The current prison environment and mental health status of incarcerated persons are
challenging and complex to navigate due to the malingering and intentional behavior of inmates.
The consequence is that many of the inmates with a significant mental illness fall through the
cracks and do not receive adequate psychiatric care. An increased risk of suicide was also
associated with a conviction for criminal homicide, sexual offenses, and other violent offenses.

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The most vital clinical risk factors were suicidal ideation during the current prison sentence, a
history of attempted suicide or self-harm, and being prescribed psychotropic medications.
Institutional factors associated with an increased risk of suicide included being in a single cell
and having no social visits (Rosenberg, 2021).
Correctional officers nationally receive approximately 13.54 hours of mandated yearly
mental health training (Kois et al., 2020). With respect to mental health training duration, diverse
mandatory requirements vary from state to state but range anywhere from 1.5 (Tennessee) to 80
(Florida) hours of instruction (Kois et al., 2020). Arizona currently mandates four hours of
mandatory correctional officer training completed during their new correctional officer training
academy prior to becoming correctional officers. The diverse populations incarcerated
throughout the country require unique programming and supervision. This inadequate training
paired with an increased mentally ill population cause an unnecessary risk factor for suicide and
exacerbation of symptoms by mentally ill inmates. In the United States prison system, suicide is
the second leading cause of death. Suicide rates in U.S. jails are three times higher than in
prisons and nine times higher than in the general U.S. population, with over 350 jail inmates
complete suicide each year (Schaefer et al., 2016). This led to the specific question examine the
use of mental health education for correctional officers. The following question was used to
guide an evidence-based search through professional medical databases.
PICOT Question
In correctional officers (P), how does mental health training (I), compared to the correctional
officers who do not receive training (C), reduce mental health stigma, and improve prisoner care
outcomes (O), three months after training delivery (T).
Search Strategy

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This literature review included a search of the following databases: Cumulative Index of
Nursing and Allied Health Literature (CINAHL), PsycINFO, and PubMed. Keywords had: new
correctional staff, prison staff, prison, private prison, mental health stigma, mental health
awareness, mental illness, mental health for service, educational intervention, workshops,
training, programs, and course. The initial search of correctional officers AND mental health
AND training yielded five results in CINAHL, 35 marks in PubMed, and 76 results in
PsycINFO. Search limits were set to include publication dates between 2015 – and 2021,
research articles, and English language. This resulted in a yield of 5 in CINAHL, 32 in PubMed,
and 60 in PsycINFO. To further narrow the search, a combination of the keywords was changed
to include mental health awareness, prison employees, psychiatric illness, workshops or training
or program or course.
Additionally, the search was narrowed to show studies specific to training to yield a final
result of 23 in CINAHL, 24 in PubMed, and 29 in PsycINFO. Grey literature of government
publications from the Centers for Disease Control and Prevention and Arizona State government
policies were also searched. After reviewing the abstracts and titles of the final yield, inclusion
criteria included articles addressing intervention training programs. Rapid critical appraisals
were then completed for 20 peer-reviewed articles, and the final ten articles were then chosen for
this literature review. This included four qualitative studies, one observational study, two
randomized controlled trials, one cross-sectional study, three mixed-method studies, and two
systematic reviews. Exclusion criteria included articles written before 2015, studies from
countries other than the United States, public safety personnel, dissertations, and articles with
continuing education unit (C.E.U.) as the principal purpose (Appendix A and Appendix B).
Evidence Synthesis

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The systematic search using the Iowa Model Revised as the framework led to finding
three evidence-based methodologies that applied to correctional officers. The rest of the
evidence-based implementation projects were designed for police officers and first responders
and could not be applied to correctional settings. The first of the three studies conducted by
Mcneeley & Donley (2021) reviewed 4,800 prison incidents following crisis intervention
training for correctional officers. This study suggests that Crisis Intervention Team (C.I.T.)
equips correctional officers with the knowledge they need to help deescalate using force. The
conclusion of the study was based on a review of 4,800 incidents over 10 years. This study
identified education as a significant factor in training. The second study specific to correctional
officers was a 6-day workshop that targeted cognitive, psychoeducation, and behavioral
components of publicly expressed stigma(s) of correctional officers (Melnikov et al., 2017). The
study was implemented and completed in prison in Israel in 2014. This study also highlighted
psychoeducation as a significant factor in the participants' survey(s) received, as well as a call for
The last study specific to correctional officers was completed by Dr. Dana Dehart and
Aidyn Iachini (2019) at the University of South Carolina. The project was a three-step process
for developing and implementing a curriculum for training correctional officers in mental illness
in prison. Of the three studies, the third study was chosen as the model to follow for the Doctor
of Nursing (DNP) evidence-based project for several key reasons. In all three studies, there was a
statistical significance in the change in the attitude of correctional officers regarding inmates
who are mentally ill. Lastly, all of the studies show statistical significance when measuring a
change in knowledge, perception, and stigma of mental illness.
The purpose of the training was to enhance correctional officer knowledge using the evidence
that best supported understanding mentally ill inmates in prison. The first study conducted by

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Mcneely & Donley (2021) was excluded due to the potential change in practice that it would
cause at the correctional facility where the project site would be implemented. The use of Crisis
Intervention Teams (C.I.T.) would not be usable at the project site due to current policy and
practice. This would cause a change in routine and would discourage the project site from
approving a D.N.P. practice project from being completed. The second study conducted by
Melnikov et al., 2017, was also excluded because the project was completed in a different
country and had a prison demographic population that would significantly differ from the United
States prison population(s). The third project completed by Dehart & Iachini (2019) was chosen
as the evidence-based model for implementation of the current D.N.P. practice project due to the
significant change in pre/post-tests of knowledge and the emphasis on delivering education to
subjects.
Theory and Framework
The Theory and framework implementation serve as a guide to organize and disseminate
information following a tested methodology. Identifying patterns in human behavior and being
able to articulate those behaviors into processes is theory and framework at work. Evidencebased models furthermore support the use of guided research and implementation following
current nursing theory (Bates et al., 2018). Interdisciplinary team approaches to care is an
efficient way to guide nursing research toward investigating mechanisms through which disease
and health disparities develop, offering a powerful means of primary prevention during early life.
The integration of using This forward-thinking mentality is desperately needed in our
compartmentalized and overburdened health system (Bates et al., 2018).
Theory of Planned Behavior

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The Theory of Planned Behavior developed by Ajzen and Madden (1985), gives a
foundation for theoretical guidance for the project (Appendix C). The negative learned behavior
toward inmates with mental health comes from a lack of knowledge about the population and its
needs. The Theory of Planned Behavior attempts to break down actions and behaviors by
explaining the underlying foundations that lead to a behavior. The learned knowledge will
change the attitude towards a particular issue and impact behaviors. According to Ajzen &
Madden (1985), attitudes towards the behavior, subjective norms, and perceived behavioral
control can predict behaviors accurately. These intentions work together with perceptions of
behavioral control and account for the considerable variance in actual behavior. The topics
outlined in the Theory of Planned Behavior can be represented by correctional officers and their
current perception of inmates with mental illness.
Attitude towards behavior: Negative attitude towards inmates who are mentally ill.
Subjective Norm: Correctional officers will have each other's back and not intervene due to
established group norms and fear of retaliation.
Perceived Behavioral Control: Correctional officers perceive themselves as authority figures
and must establish safety through disciplinary action.
Intention: Correctional officers have the intention to treat inmates with empathy but have strong
biases directed correlated to several years working in prison.
Behavior: the correctional officer's behavior toward mentally ill inmates is not standard;
therefore, work needs to be done to improve knowledge in the population who manages the
majority of this country's mentally ill.

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Furthermore, the theoretical framework is the underpinnings of this project and will be based on
changing correctional officer attitudes toward mentally ill inmates. Key concepts and
relationships are the way that theories are made and developed. Explaining phenomena and the
world around us through patterns, key concepts, and norms helps us better understand our world
and, more importantly, predict changes in our field. The foundational concepts in the Planned
Behavior Theory are specific and measurable, particularly in a population of correctional
officers.
Iowa Model of Evidence-Based Practice
The Iowa Model is a widely used framework for implementing an evidence-based
practice developed in the early 1990s by a team of nurses from the University of Iowa Hospitals
and Clinics (UIHC). The goal of the model was to promote quality care to guide clinicians in
evaluating and infusing research findings into patient care. The Iowa Model was based on
Roger's Theory, Diffusion of Innovations, and was an outgrowth of the Quality Assurance Model
Using Research (Buckwalter et al., 2017). This framework was chosen due to the scientific
underpinnings of practice and the model to implement evidence-based practice. The Iowa Model
covers several of the essentials of Doctoral Education for Advanced Nursing Practice proposed
by the American Association of Colleges of Nursing (ANCC). This framework is straightforward
and promotes using the best evidence available to make improved healthcare decisions for our
patients. The model offers a systematic approach to finding research and implementing the
findings. Lastly, the Iowa model provides a step-by-step protocol to be followed that starts with
identifying current issues/opportunities and ends with the integration of practice change followed
by dissemination of results (Appendix D). Following the protocol has been similar to the
educational foundations currently mandated by the ANCC, emphasizing evidence-based practice.

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Methods
Project Site
The project site was a prison located in the Southwestern United States which housed
approximately 1900 inmates at any given time with a max capacity of 2000 inmates. One
hundred fifty-two-man cells (~300 inmates) are available for vulnerable populations and consist
of the following: Administrative Segregation: Gang, Drug, Violation, Investigation; Protective
Custody: Inmates owe money to other inmates, inmates convicted of sexual crimes, domestic
abuse against women/children/elderly; Mental Health Observation Overflow; 2 single-man cells
are reserved for mentally unstable inmates. These two cells have been equipped with an
enhanced security door and with windows to improve continuous visual observation of the
inmate. Additionally, beds are lower to the ground to reduce the risk of hanging or serious injury.
Based on the above description, approximately 1600 inmates are in the general population and
account for most of the encounters that correctional officers have daily.
Internal Review Board Approval
The Internal Review Board (I.R.B.) for the prison granted approval for the
implementation of the Doctor of Practice project in July of 2021. The prison I.R.B. requested
that any publication of the project note that this training was provided as supplemental education
and did not change or replace the current prison policy. Arizona State University I.R.B. approval
was granted in October of 2021 with expedited approval.
Participants
Participants for this project were recruited during the correctional facilities new
correctional officer training program. Participants were provided with a description of the project
and then signed an informed consent. To insure the privacy of the participants, no identifying

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information was placed on the project documents. Participants were assigned a number to allow
paired analysis of data. Data was stored on a password protected laptop. Only the project
coordinator had access to the data. Once data analysis was completed, the data was destroyed.
Inclusion criteria for participants included new correctional officers over the age of 18,
with less than three months of experience. Exclusions included employees who were not
correctional officers, such as medical, kitchen, and maintenance. Participation in this project was
not paid, and the training was categorized as supplemental training by the private correctional
facility. Participants were asked to take a demographic survey identifying age, gender,
experience, and education levels. Participants were provided a National Institute of health
resource. The resource gave participants community mental health resources if needed
(Appendix E).
The curriculum developed by Dr. DeHart has a total of 20 modules that encompass the
complete training curriculum based on the needs assessment that was done in 2018 for 50 prisons
in her area. However, only four modules were delivered to new correctional officers. The four
chosen modules were picked based on the overall general knowledge they provide. A need for a
basic understanding of mental health was the focus of the training to promote the reduction of
mental health stigma. The four topics were taught in a classroom setting as part of their new hire
orientation training program (Appendix F). The information was presented over a period of six
hours with the first and last hours used to conduct pre/post-tests to assess knowledge. The
participants also completed the MAKS assessment related to stigma and attitudes towards mental
health in prison before and after the education sessions. Permission to utilize these modules was
obtained by Dr. Dehart. The curriculum and module content is outlined below (table 1).
Table 1

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Modules & Corresponding Competencies for Correctional Officers

Question

Outcome

Outcome

Module 1

What is mental
health?

Recognize that mental
health includes multiple
dimensions, such as
emotional,
psychological, and
social aspects.

Describe and
compare criteria for
defining a mental
disorder versus
serious mental
illness.

Module 2

DeInstitutionalization
and
Criminalization

Recognize the roles that
de-institutionalization
and criminalization
(e.g., addiction,
hopelessness, poverty)
play in increasing the
number of people in
correctional institutions
who have mental
disorders and histories
of trauma and
adversity.

Module 3

Understanding
Trauma

Module 4

Managing
Workplace Stress

Recognize that the
correctional setting can
mirror or trigger past
traumatic experiences
of the person who is
incarcerated
Identify sources of
workplace stress and
burnout.

Describe contextual
stressors that can
cause traumatic
stress for people who
are incarcerated.
Describe resources
and strategies for
addressing
workplace stress.

Statistical analysis was completed for the Pre-test and Post-tests and MAKS results using
a paired-t-test to compare pre/post data.
Measurement/Tools

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The Mental Health Knowledge Schedule (MAKS) is an instrument to assess stigmarelated mental health knowledge among the general public. The MAKS is a straightforward and
feasible method for evaluating and tracking stigma-related mental health knowledge and can
facilitate the evaluation of large-scale anti-stigma interventions, and will allow for better
understanding in the future of how knowledge, attitudes, and behavior interrelate. The 12 items
of the MAKS are scored on a Likert scale (from 1: "Strongly Disagree" to 5: "Strongly Agree").
"Do not know" is coded as neutral (value of 3). The MAKS questionnaire is articulated into two
parts (Appendix G). The first six statements are related to mental health knowledge, which gives
the possibility to calculate a total score. Items from 7 to 12 refer to six clinical conditions to
identify the levels of recognition and familiarity with those clinical situations (Thornicroft et al.,
2015). The MAKS was found to be a brief and feasible instrument for assessing and tracking
stigma-related mental health knowledge. The MAKS demonstrated overall moderate to
substantial test–retest reliability (Evans-Lako et al., 2010). In addition to the MAKS
questionnaire, a 10-question trauma quiz provided by Dr. DeHart in order to assist her with her
continued research (Appendix H). The quiz was reviewed for face validity by Doctor of Nursing
Practice professors and peers.
Results
Participants were primarily male (57%), Caucasian (42%), with an average age of 31-40
years old. More than 42% of participants had some college education (table 2). Statistical
improvement was seen for pre and post test scores for the 10 item quiz (table 3 and table 4).
There was also a mean change in the MAKS scale from 54 pre-survey and 63 post-survey
for the MAKS questionnaire. Improvement in knowledge was seen following the education
compared to pre-education quiz scores. Also, the mean MAKS score improved form 54 pre-

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

21

education to 63 post education demonstrating an improvement in stigma related mental health
knowledge (table 5).
Table 2
Frequency Table for Nominal Variables
Variable
Gender
Male
Female
Missing
Race
Pacific Islander
African American
White American
Hispanic
Missing
Education
High School
Some College
Graduate Degree
College Degree
Missing
Relationship_Status
Divorced
Married
Single
Dating
Missing
Age
31-40
51-60
>60
22-30
Missing
Political_Affiliation
Republican
Independent
I prefer not to say
Missing
Armed_Forces
Marines
None
Federal Employee

n

%

4
3
0

57.14
42.86
0.00

1
2
3
1
0

14.29
28.57
42.86
14.29
0.00

2
3
1
1
0

28.57
42.86
14.29
14.29
0.00

2
3
1
1
0

28.57
42.86
14.29
14.29
0.00

2
2
1
2
0

28.57
28.57
14.29
28.57
0.00

2
4
1
0

28.57
57.14
14.29
0.00

3
3
1

42.86
42.86
14.29

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING
Missing
Note. Due to rounding errors, percentages may not equal 100%.

22
0

0.00

Table 3
Summary Statistics Table for Interval and Ratio Variables
SEM
Variable
M
SD
n
Min
Max
Skewness
Participants
4.00
2.16
7
0.82
1.00
7.00
0.00
Pre
7.71
1.38
7
0.52
5.00
9.00
-1.10
Post
10.00
0.00
7
0.00
10.00
10.00
Note. '-' indicates the statistic is undefined due to constant data or insufficient sample size.

Kurtosis
-1.25
0.22
-

Table 4

Two-Tailed Paired Samples t-Test for the Difference Between Participants and Pre
Participants

Pre

M
SD
M
SD
t
3.00
1.83
8.50
0.58
-5.74
Note. N = 4. Degrees of Freedom for the t-statistic = 3. d represents Cohen's d.

p
.010

d
2.87

Two-Tailed Paired Samples t-Test
Table 5
Two-Tailed Paired Samples t-Test for the Difference Between MAKS_PRE and MAKS_POST
MAKS_PRE
MAKS_POST
M
SD
M
SD
t
59.29
4.46
64.00
2.83
-3.67
Note. N = 7. Degrees of Freedom for the t-statistic = 6. d represents Cohen's d.

p
.010

d
1.39

The results of the pre and post-test are clinically significant, showing improved
knowledge for correctional officers. The results of the project show how brief psychoeducation
can increase mental health knowledge of participants. However, due to the small number of
participants, statistical significance not met. Due to the small sample size, descriptive statistics
are limited and do not show significant correlations. This intervention provides mostly positive
results with psychoeducation training in corrections.
Discussion

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

23

The primary goal of this study was to identify how brief evidence-based education would
impact new correctional officers' stigma toward mentally ill inmates. The participants showed
significant improvement in baseline knowledge which was reflected in the post-surveys.
Correctional officer mental health stigma also improved following psychoeducation as evidence
by improved MAKS scores. Examining the role of a correctional officer in relation to mental
health in prison also allows us to review critical situations that could be improved. For this
reason, a module on understanding trauma was delivered to participants. It was critical for
participants to understand inmates' previous trauma and their role in reducing triggers that could
exacerbate situations and cause negative events. Larger groups of participants are necessary for
future research in order to identify the statistical importance of this intervention. This shift to a
trained correctional officer is valuable and supported by evidence. Additional potential positive
impacts of this project include an improved correctional environment, reduction in recidivism,
improved inmate outcomes, and reduction of suicide in jail/prisons.
Participants also reported that the training was beneficial, and they would recommend
this to peers and all correctional staff. One of the major positives that were reported was the use
of an instructor led curriculum that made a difference in the delivery of information. The
instructor led training was better received than self-paced participant module training. Large
prevalence studies show that when comparing correctional officers to other occupations, prison
employees are exposed to a higher risk of injury than any other job (McNeely, 2021). The
application of this training program produces officers who are more knowledgeable and able to
navigate difficult conversations with mentally ill inmates. This alone has a potential to reduce
injury to inmates and correctional officers by reducing the use of force events. Current literature
recommended increased training for correctional officers in order to reduce staff and inmate

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

24

injury. The review of literature identified that correctional officer stigma played a major role in
incident outcomes. Furthermore, the literature highlighted the need for increased mental health
training in the prison system.
Mcneely and her team suggest inmate-on-staff assaults could be reduced through
ongoing, intensive training on recognizing common signs of violence, deescalating situations,
and effectively using protective measures such as physical force, restraints, and chemical irritants
(Mcneely, 2021). The curriculum in this project is web-based and can be rapidly distributed to
any correctional facility in the country. The potential rapid distribution of this web-based
information makes this curriculum unique to other training programs. Lastly, the education that
this training provides is completely free, which eliminates the need to purchase this training.
Furthermore, correctional facilities attract many military veterans who can easily
transition from military to civilian life yet have their unhealed trauma (Moran et al., 2019.
Baseline knowledge scores of new correctional officers who have never set foot behind the steel
bars have less bias. Significant findings from this exploratory project showed that
psychoeducation training had a positive impact on correctional officer knowledge with no
adverse outcomes. Correctional officers showed overall positive changes in their knowledge of
mental illness and their knowledge of mental health disparities within the prisons. In addition,
significant improvement in trauma knowledge was assessed when comparing pre/post-test
scores.
Limitations/Barriers
Limitations to this study must be acknowledged. First, the sample was small (n = 7).
Duplication of this project with a larger group is needed to determine the effectiveness of this
training. The modules utilized for this project only account for less than 25% of the total

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

25

curriculum available for presentation. The impact of utilization of the total curriculum should be
investigated. Longitudinal studies of the use of force incidents post psychoeducation intervention
would be helpful to identify the effectiveness of increased correctional officer mental health
knowledge on the frequency of these incidents.
COVID-19 impacted the number of participants for this project due to the low number of
correctional officer applicants to the correctional facility. The usual average class sizes for new
correctional officers is fourteen participants. More participants for this project may have yielded
different results.
Sustainability/Feasibility
The project could be sustained by local training managers at each correctional facility.
Training managers ensure that all employees who work at the prison complete required training
and are current with accreditations and state/local laws. Use of the training modules can be added
to yearly required training. Furthermore, if correctional facilities choose to be accredited by the
National Commission on Correctional Health Care (NCCHC), they must provide yearly
correctional officer mental health training. By implementing the curriculum for this project
delivered at this facility, correctional facilities would meet NCCHC standards and deliver
evidence-based education to all correctional staff.
Conclusion
Utilizing evidence based, instructor-led mental health training can improve knowledge
and reduce stigma. Stigma reduction could significantly improve negative mental health
perceptions and reduce adverse outcomes related to managing mentally ill inmates. Essential
training topics related to mental health must be part of the training provided to correctional
officers and, at the very minimum, should include the following. Currently, every state has a

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

26

minimum mandatory of mental health education for correctional officers. Exploring ways to
improve mental health education to correctional officers is key to decrease mental health stigma.

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

27

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Appendix A
Ten Studies Supporting enhanced education for Correctional Staff.
Citation

Theory/
Conceptual
Framework

Kubiak et al., (2019).
Enhancing knowledge of
adolescent mental health
among law enforcement:
Implementing youthfocused crisis intervention
team training.

Theory of
Planned
Behavior
(Ajzen, 1991)

Funding: Provided by the

Governor’s Mental Health
Diversion Council and the
Michigan Department of
Health & Human
Services.

Bias: Informal

Intervention
Research
Framework
(Fraser,
Richman,
Galinsky, &
Day, 2009)

Design/
Method/
Sampling
(Grounded
Theory,
phenomenology,
Narrative…)
Design: 143
Officers in
County A/B
received Crisis
Intervention
Training for
Youth (CRT-Y)
(Pre/Post Test
with 26 item
questionnaire and
6 month follow up
Purpose: This
initial
investigation of
CIT-Y
implementation
was conducted in
two counties in a

Sample/Setting
(describe)

Major
Themes
Studied/
Definitions

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)

Data Analysis

Findings/
Themes

N:129
n: County A 85
officers
n: County B 58
officers
Setting:
Midwestern
State, Baltimore
County Police
Department
Sample: 143
Police Officers
received CIT-Y
training.
Demographics:
92 males (79%),
25 females
(21%) Of the

IV: Crisis
Intervention
Teams for
Youth (CITY), aimed at
addressing
these
concerns.
CIT-Y is an
advanced
training model
that aims to
divert youth
with mental
health
problems from
the
criminal/legal

Scale: The percent of
missing values varied
from 0.8% to 3.1% per
variable. Fifteen
questions were reverse
coded to ensure
consistency of the
scale for data analysis.
Pre- and post-test
scores were calculated
by summing all 26
items in the
questionnaire,
resulting in a possible
range of scores
between 26 and 130.
Change scores were
also calculated by

Paired samples ttests were used to
assess pre- and
post-test change.
To identify
potential factors
associated with
uptake — bivariate
analyses (e.g.,
Pearson
correlation test;
independent
sample t-test) were
run to test for
differences in
outcomes by
officer
demographics.

The findings
of this study
confirmed
that CIT-Y
training was
feasible in
these counties
and
acceptable to
the officers
who
participated.
Outcomes
from the
pre/post-tests
show that
86% of
officers

Level/Quality
of Evidence;
Decision for
practice/
application to
practice/
Generalization
Strengths:
Overall, the preand post-test
instruments
showed
significant
positive
outcomes
resulting from
the CIT-Y
training
Weaknesses:
small sample,
only 2 counties,
unable to
correlate officer
knowledge and

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IV- Independent Variable. CO:
Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS SPSS Version 25: Statistics is
the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis Intervention, ASU:
Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all incarcerated males
with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance
Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2: Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability
to manage interaction. MI = mental illnesses; ANCOVA = analysis of covariance. A-Paired t test conducted on CIT pre- and post-data. b ANCOVA utilized to test differences between post-CIT and
non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment, PSSC: Public Safety
Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA: Multivariate analysis of
covariance. IMI: Individuals with Mental Illness. DOC: Department of Corrections, MHP: Mental Health Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law
Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form:
The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized
controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP: brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not
reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING
Citation

observations
Country: Southwestern
area, United States.
Urban County in the
Southwest area (just above
200,000) & County in
Metropolitan regional in
the Southwest area
(population over 1 million

Theory/
Conceptual
Framework

Design/
Method/
Sampling
(Grounded
Theory,
phenomenology,
Narrative…)
Midwestern state.
Feasibility,
acceptability,
fidelity, and
outcomes of this
supplemental
training were
assessed using
multiple methods,
which included
researcher
observations of
training sessions,
interviews with
law enforcement
training

35

Sample/Setting
(describe)

Major
Themes
Studied/
Definitions

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)

129 officers,
one-third were
from County B
(n = 46, 35.7%)
and two-thirds
from County A
(n = 83, 64.3%).
The majority of
officers were
male (75.8%,
n = 97) and a
minority had a
graduate degree
(11.7%, n = 15).
Officers who
participated in
the training
varied in their
tenure in law
enforcement,
averaging 14
years (SD = 8.4)
and ranging
from less than

system

taking the difference
between post and pretest scores. Paired
samples t-tests were
used to assess pre- and
post-test change.

Data Analysis

The transcripts
were coded by two
team members,
and 33% of the
transcripts were
dually coded to
establish interrater reliability
(IRR). Initially,
84% IRR was
established and
after a review by
the team and
discussion of the
differences, the
two team members
coded two
additional
interviews, with a
new score of 90%
IRR. A case-level
ordered metamatrix was

Findings/
Themes

positively
changed their
knowledge
and attitudes
regarding
youth with
mental health
problems.

Level/Quality
of Evidence;
Decision for
practice/
application to
practice/
Generalization
outcomes in
community.

participants, and
pre/post-test
instrument analysis.
A review of the
project by the
university’s
institutional review
board (IRB) deemed
this evaluation
CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IV- Independent Variable. CO:
Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS SPSS Version 25: Statistics is
the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis Intervention, ASU:
Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all incarcerated males
with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance
Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2: Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability
to manage interaction. MI = mental illnesses; ANCOVA = analysis of covariance. A-Paired t test conducted on CIT pre- and post-data. b ANCOVA utilized to test differences between post-CIT and
non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment, PSSC: Public Safety
Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA: Multivariate analysis of
covariance. IMI: Individuals with Mental Illness. DOC: Department of Corrections, MHP: Mental Health Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law
Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form:
The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized
controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP: brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not
reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING
Citation

Theory/
Conceptual
Framework

Design/
Method/
Sampling
(Grounded
Theory,
phenomenology,
Narrative…)
research as exempt
from human
research oversite.

Sample/Setting
(describe)

one year to 38
years of
experience. Two
out of every
three officers
(64.8%, n = 81)
are currently
raising or have
previously
raised an
adolescent child.

Major
Themes
Studied/
Definitions

36
Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)

Data Analysis

developed to
present and cluster
the data, which
allowed for the
testing of
assumptions of
the acceptability of
the training and a
deeper
understanding of
the data

Findings/
Themes

Level/Quality
of Evidence;
Decision for
practice/
application to
practice/
Generalization

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IV- Independent Variable. CO:
Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS SPSS Version 25: Statistics is
the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis Intervention, ASU:
Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all incarcerated males
with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance
Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2: Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability
to manage interaction. MI = mental illnesses; ANCOVA = analysis of covariance. A-Paired t test conducted on CIT pre- and post-data. b ANCOVA utilized to test differences between post-CIT and
non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment, PSSC: Public Safety
Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA: Multivariate analysis of
covariance. IMI: Individuals with Mental Illness. DOC: Department of Corrections, MHP: Mental Health Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law
Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form:
The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized
controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP: brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not
reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Citation

DeHart, D., & Iachini, A.
(2019). Mental Health &
Trauma among Incarcerated
Persons: Development of a
Training Curriculum for
Correctional
Officers. American Journal of
Criminal Justice, 44(3), 457–
473.
https://doi.org/10.1007/s12103019-9473-y

Funding: United States
Department of Justice, Bureau
of Justice Assistance
Bias: 10 item pre/post-test,

37

Theory/
Conceptual
Framework

Design/ Method/
Sampling
(Grounded
Theory,
phenomenology,
Narrative…)

Sample/Setting
(describe)

Major Themes
Studied/
Definitions

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)

Data Analysis

Findings/
Themes

Strauss, A., &
Corbin, J.
(1991). Basics
of qualitative
research:
Grounded
theory
procedures
and techniques

Qualitative
Grounded
Theory; Three
Phase Process.
Needs
Assessment:
research review.
Interviews
included
correctional
officers, prison
administrators,
prison medical
personnel.
Media
Development:
Creation of
curriculum to
include PDF
facilitator’s
manual,

N: 50 prison
staff
n: Correctional
officers (30),
clinical staff (7),
Wardens (7),
and advisory
board staff (6).
Setting: 20
different
locations
throughout the
state.
Sample:
Training
participants
included one
group of 29
officers with
prior training in
crisis

Correctional
officers who
attended a
pilot test of
the training
demonstrated
increased
knowledge
from pretest to
posttest, and
officers rated
the training
positively.
Their oral and
written
feedback
indicated that
the training
was helpful
both in
alerting them

Analyses of pilot data
were conducted using
IBM SPSS Statistics
(Version 25).

Mean ratings on
course content
and delivery
methods were
positive overall,
with the content
being perceived
as clear (M =
4.23, SD =
0.78), applicable
on the job (M =
4.17, SD =
0.87),
meaningful (M =
4.10, SD =
0.90), and to a
lesser extent,
appropriate to
the length of
time allocated
for the training

Greater
knowledge
and
awareness of
mental health
of offenders
may assist
these officers
to be more
effective
collaborators
with mental
health
personnel in
universal
screening,
referral for
assessment,
identifying
special
circumstances

Descriptive statistics
for participant
demographics and
course evaluation
ratings.
Analyses of variance
were used to examine
between-group
differences in
knowledge scores and
within-group
knowledge from pretest to post-test.

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
Level II
Evidence-based
material
applied as
intervention.
Strengths:
Curriculum
went through a
specific needs
assessment prior
to development,
multifaceted
delivery
methods, at
home delivery
available.
Weaknesses:
small size,
biased
demographic
factors may

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING
Citation

notetaking for recordkeeping.
Interviews were led by a
project staff member with prior
experience using shorthandstyle notes in correctional
settings, only 2 interviewers.
Location: unknown 50
officers attending came from
20 different locations across
the prison system.

Theory/
Conceptual
Framework

Design/ Method/
Sampling
(Grounded
Theory,
phenomenology,
Narrative…)

Sample/Setting
(describe)

Major Themes
Studied/
Definitions

participant
handouts, activity
cards, and
PowerPoint
presentations with
brief videos and
animations.
Pilot Testing:
Pilot testing
included testing
of prototypes and
technology,
piloting activities
and videos with
staff and
professional
colleagues,
classroom
delivery of
selected portions
of the training to
two different
audiences, and

intervention and
one group of 21
officers with no
such prior
training.
Demographic:
66% were
women, 86%
were African
American, 14%
Caucasian

to signs of
trauma as well
as in
managing
their own
stress on the
job.

Within our
sample, 4 % of
officers had
been on the job
less than 1 year,
23 % between
one and 5 years,
and 73 % more
than 5 years (no
comparable
demographic is

38
Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)

Data Analysis

Findings/
Themes

(M = 3.88, SD =
1.08) and new to
the learner (M =
3.27, SD =
1.33).

for exemption
from
discipline,
and
identifying
least
restrictive
options to
avoid
seclusion and
restraint. This
online
curriculum
may also be
suitable for
training
student
interns or
those
studying for
correctionsbased work in
fields of

Qualitative
responses were
reviewed by the
first author, and
representative
quotes were
selected to
illustrate
overarching
themes
mentioned on
evaluation
forms.

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
have
implications for
generalizability
of findings,
particularly if
women, persons
of color, or
experienced
officers may be
more receptive
to training on
issues of
trauma, selfcare, or mental
health in
general. Thus,
piloting
additional
modules and
training a range
of participant
groups—
including men,

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING
Citation

Theory/
Conceptual
Framework

Design/ Method/
Sampling
(Grounded
Theory,
phenomenology,
Narrative…)
analyses of data
from pre/posttests and course
evaluations.

Sample/Setting
(describe)

available in state
administrative
data).

Major Themes
Studied/
Definitions

39
Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)

Data Analysis

Findings/
Themes

social work,
psychology,
and public
health.

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
whites, Latinx,
Asians,
American
Indians,
Hawaiians, and
Alaskan
Natives—will
help establish
utility of the
training for
broader
purposes.

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

Running head: DNP PROJECT FINAL REPORT

Theory/
Conceptual
Framework

Citation

Mcneeley, S., &
Donley, C. (2021).
Crisis Intervention
Team Training in a
Correctional
Setting: Examining
Compliance, Mental
Health Referrals,
and Use of
Force. Criminal
Justice and
Behavior, 48(2),
195–214.
https://doi.org/10.11
77/00938548209593
94

Funding:
Minnesota

Logistic
regression
using the
SAS
system:
Theory and
Application
. SAS
Institute.

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)
Design: This study
compares outcomes
of prison incidents
involving CIT
officers to incidents
without CIT-trained
officers.
Purpose: Crisis
Intervention Team
(CIT) training was
introduced in
MnDOC facilities in
2011 (see Minnesota
Department of
Corrections, 2015).
The training is
intended to expand
correctional officers’
understanding of
mental illness,
provide tools to

Sample/Setting (describe)

N: Reports on 4,812
incidents that appeared to
be eligible for the study
were written during the
study period.
N: This study analyzes
reports from 500 incidents
that occurred at Minnesota
Correctional Facility
(MCF)-Oak Park Heights
between October 12, 2016,
and March 31, 2018.
Setting: Minnesota
Correctional Facility Oak
Park Heights which
contains the Administrative
Control Unit (ASU).
Mental Health Unit (MHU).
Transitional Care Unit
(TCU)

40

Major Themes Studied/
Definitions

Intervention: Evaluation
of use of CIT
interventions by
correctional officers.
DV: Immediate
Compliance (62.2%)
Eventual Compliance
((34.4%)
Mental health referral
(5.4%)
Use of Force (19%).
IV: Use of CIT
technique during incident
Proportion of employees
present during incident
who had received CIT
training.
CV: Situational
Characteristics from

Measurement/
Instrumentation
(focus group,
1:1, open-ended
survey)

Data
Analysis

Findings/
Themes

Scale: In
particular, since
there are 65
incidents with
eventual
compliance, 95
incidents with
use of force, and
27 incidents in
which staff
made referrals,
there should be
no more than 13,
19, and five
predictors in
these models,
respectively. To
account for this,
we used
backward
elimination

The use of
CIT
techniques
was
positively
related to
whether,
after initially
being
noncomplian
t, an
incarcerated
person
eventually
agreed to
comply with
instructions
(r = .184, p =
.011). Both
the use of
CIT

The results
suggest CIT
training can
in some
ways be
beneficial in
a prison
setting, as it
is related to
gaining
compliance
from unruly
incarcerated
people and is
associated
with
officers’ use
of mental
health
referrals.

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
LEO: Level II
Strengths: This
suggests CIT
training equips
correctional
officers with the
knowledge they
need to help
incarcerated
people obtain
appropriate mental
health care. This is
beneficial not only
for the health of
the incarcerated
person but also for
the safety of other
incarcerated
people and staff
and for the

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

Department of
Corrections.
Bias: Single events
in maximum
security facility.
Unable to generalize
to facilities with
lower custody
levels. All male
prison facility.
Location:
Minnesota
Department of
Corrections.

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)
support intentional
communication
between officers and
incarcerated people,
and educate officers
on interventions for
those experiencing
mental health crisis
(Dupont & Cochran,
2000).

Sample/Setting (describe)

Sample: 308 employees
who responded to incidents.
Demographic: Nearly
three quarters (72%) of
employees were male,
while 28% were female.
The majority of employees
identified as White (78%),
while 4% were Black, 4%
were Asian, 2% were
Hispanic, 1% were
American Indian, and 12%
were unknown or other.
The employees ranged in
age from 19 to 66 years,
with an average of 38 years.
The employees had worked
for MnDOC for an average
of 8 years; the length of
employment ranged from
less than 1 year to 33 years.

Major Themes Studied/
Definitions

situations:
Time of day
Morning Watch (06451434)
Second Watch (14352224)
Third Watch (22250644)
Location: cell,
ASU,MHU, TCU,
kitchen, medical,
recreation, commissary.

41

Measurement/
Instrumentation
(focus group,
1:1, open-ended
survey)
stepwise
regression
(likelihood
ratio) to select
the best fitting
models with the
appropriate
number of
predictors.

Data
Analysis

techniques (r
= .196, p <
.001) and the
proportion
of
employees
with CIT
training (r =
.142, p =
.002) were
positively
related to
mental
health
referral.

Findings/
Themes

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
operation of the
facility.
Weaknesses:
Subjective Officer
Choice to submit
incident report:
brief conversation
before an
incarcerated
person acted out,
officers may not
have felt it
necessary to
submit an incident
report. Therefore,
it is possible that
CIT officers have a
more positive
impact than could
be detected in this
study. It is

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Citation

Theory/
Conceptual
Framework

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)

Sample/Setting (describe)

Major Themes Studied/
Definitions

42

Measurement/
Instrumentation
(focus group,
1:1, open-ended
survey)

Data
Analysis

Findings/
Themes

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
important to note
that incident
reports are only
recorded when
employees
perceive a threat to
staff or resident
safety or to the
proper operation of
the facility.

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

Melnikov, S.,
Elyan‐Antar, T.,
Schor, R.,
Kigli‐Shemesh, R.,
& Kagan, I. (2017).
Nurses Teaching
Prison Officers: A
Workshop to
Reduce the
Stigmatization of
Prison Inmates With
Mental
Illness. Perspectives
in Psychiatric
Care, 53(4), 251–
258.
https://doi.org/10.11
11/ppc.12165
This study is based
on a convenience

A unitary
theory of
stigmatizati
on: Pursuit
of selfinterest and
routes to
stigmatizati
on.

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)
The 6-day workshop
targeted the
cognitive,
psychoeducational,
and behavioral
components of
publicly expressed
stigma. It combined
theoretical learning
with practical
experience in
identifying the
symptoms and coping
with the
manifestations of
mental illness.
Across 4 days of
theoretical learning
(32 study hours) and
2 days of
observational

Sample/Setting (describe)

This study is based on a
convenience sample of 83
prison officers from various
prisons in Israel who
attended the workshop
between December 2013
and February 2014.
Participation in the
workshop gave the officers
credits for continuous
education compensation.
Four workshops took place
altogether, with an average
of 20–25 participants in
each group.

V1: SD Preworkshop: 2.94,
post 2.72

Major Themes Studied/
Definitions

Major Themes:
Stigmatizing attitudes
lead to improved
professional practice
with respect to the
persons with mental
illness in prison facilities
Perhaps such workshop
interventions ought to be
incorporated into the
training of novice prison
officers, especially in
prisons that provide
psychiatric care services,
such as outpatient clinics
and psychiatric wards.

43

Measurement/
Instrumentation
(focus group,
1:1, open-ended
survey)
The structured
selfadministered
questionnaire
was designed to
explore the
cognitive,
affective, and
behavioral
elements of
stigmatization
according to the
Haghighat
(2001) model of
public stigma.

Data
Analysis

Findings/
Themes

Pearson’s
correlation
coefficients
were used
for testing
intervariable
relationships
. t-Tests for
independent
samples and
paired
samples
were
calculated to
compare
variables.
Multiple
regression
analyses
quantified
the unique

The main
finding is the
decrease in
levels of
postintervent
ion
stigmatizatio
n. The
psychoeduca
tional,
psychiatric
nurse-led
intervention
seems to
have
achieved
positive
results in a
relatively
short space
of time.

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
LOE: Level II
Strengths:
Psychiatric Nurse
delivery of
education with
extensive
experience in field.
Cost effective
Rapid universal
training statewide
Weaknesses:
Sample size (N=
83). M= 60, W= 20
Gender bias.
Significant gender
differences suggest
underlying gender

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

sample of 83 prison
officers from
various prisons in
Israel who attended
the workshop
between December
2013 and February
2014.
Funding: Ministry
of Health to the
Health Funds
MHHF (Israeli
health maintenance
organizations
[HMOs] that
provide healthcare
services to citizens).

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)
experience in
psychiatric wards (16
study hours),
workshop activities
included frontal
lectures, case
reviews, general and
panel discussions,
peer supervision,
simulations in class,
observational training
in psychiatric wards
(PW).

Sample/Setting (describe)

V2: SD Preworkshop: 3.00,
post 3.68
V3: SD Preworkshop: 2.25,
post 2.25
V4: SD Preworkshop: 3.04,
post 3.14
V5: SD Preworkshop 3.7,
post 3.72

Major Themes Studied/
Definitions

44

Measurement/
Instrumentation
(focus group,
1:1, open-ended
survey)

Data
Analysis

contribution
of
independent
variables to
dependent
ones

Findings/
Themes

It is
noteworthy
that the level
of
stigmatizatio
n among
male officers
was much
higher than
among
female
officers,
both before
and after the
workshop.

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
bias that needs to
be further explored
in order to see if
curriculum
presented to
officers needs to
be gender
appropriate.

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

45

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

Canada, K., Watson, A.,
& O’kelley, S. (2021).
Utilizing Crisis
Intervention Teams in
Prison to Improve Officer
Knowledge, Stigmatizing
Attitudes, and Perception
of Response
Options. Criminal Justice
and Behavior, 48(1), 10–
31.
https://doi.org/10.1177/0
093854820942274
The University
Institutional Review
Board reviewed and
approved the study.
Funding: This project
was funded by the Fahs

Quasiexperimental,
concurrent
triangulation
mixed-method
design using a
pre- and posttest
(Creswell et al.,
2003).

Design/ Method/
Sampling
(Grounded
Theory,
phenomenology,
Narrative…)
The use of mixedmethods, multiple
data sources, and
triangulation is
critical in this
project due to the
complexity of
intersecting
factors within
prisons that
impact people
with MI. Survey
and interview data
were collected
from COs
between 2016 and
2018.

Sample/Setting
(describe)

Major Themes
Studied/ Definitions

A total of 235 COs
completed a pre- and/or
postsurvey. In the
recruitment window,
403 COs received CIT
training, making the
response rate
approximately 58% of
eligible COs, which is
just under the standard
threshold of 60% noted
by some scholars
(Johnson & Wislar,
2012). Due to staffing,
changes in attendance
were made, which
resulted in some
eligible COs not
receiving the survey
link prior to the
training.

No distinct
differences between
CIT and non-CIT
COs.
No differences
between age ranges.
Mental Health
Knowledge
significantly
increased at the posttest
Participants perceived
greater effectiveness
of the mental the
mental health system
following CIT

46

Measurement/
Instrumentati
on
(focus group,
1:1, openended survey)
All variables
described
were
collected
from both
CIT and nonCIT COs.
Demographic
variables
included age,
sex, education
level, marital
status, race
and ethnicity,
years in
position and
working for
DOC, shift,
facility, work
assignment,
and if
someone

Data Analysis

COs using
analysis of
variance
(ANOVA)
and Pearson
chi-square.
ANOVA was
used to
explore
differences
between CIT
and non-CIT
COs in all
dependent
variables.

Findings/
Themes
Findings
suggest that
CIT may
promote
change in
officer
knowledge,
stigmatizing
attitudes, and
perception of
response
options.
These
changes
should
theoretically
lead to officer
behavior
change in
encounters
involving
people

Level/Quality of
Evidence; Decision
for practice/
application to
practice/
Generalization
LOE: Level II

Strengths:
Providing COs with
additional training
and support to more
accurately respond
to people with MI
improves officer
interactions with
people experiencing
Weaknesses:
CIT COs work
alongside non-CIT
COs. It is possible
that CIT COs could

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

Beck Fund for Research
and Experimentation and
the Hammond Institute.

Design/ Method/
Sampling
(Grounded
Theory,
phenomenology,
Narrative…)

Sample/Setting
(describe)
Randomly selected CIT
COs completed
interviews 6 to 9
months following
training (n = 17). CIT
COs had significantly
lower stigmatizing
attitudes.

Major Themes
Studied/ Definitions

47
Measurement/
Instrumentati
on
(focus group,
1:1, openended survey)
close to them
has an MI.

Data Analysis

Findings/
Themes
displaying MI
symptoms or
having mental
health crises.
Based on
attribution
theory and
previous.

Level/Quality of
Evidence; Decision
for practice/
application to
practice/
Generalization
impact nonCIT COs
(i.e., contamination).

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Citation

Theory/
Conceptual
Framework

Krakauer, R.,
Stelnicki, A., &
Carleton, R. (2020).
Examining Mental
Health Knowledge,
Stigma, and Service
Use Intentions
Among Public
Safety
Personnel. Frontiers
in Psychology, 11,
949–949.
https://doi.org/10.33
89/fpsyg.2020.0094
9

The study was
designed to
determine the
relationship
among mental
health
knowledge,
stigma against
peers in the
workplace, and
service use
intentions in a
nationally
representative
sample of Public
Safety Personnel
(PSP).

Online survey
between September
2016 to January
2017. The survey

Design/ Method/
Sampling
(Grounded
Theory,
phenomenology,
Narrative…)
The Mental
Health
Knowledge
Scale (MAKS;
Evans-Lacko et
al., 2010) is a
15-item selfreport
questionnaire.
The first six
items assess
beliefs about
mental health.

Sample/Setting (describe)

In total, n = 8,520 began
the survey and n = 4,108
(48.2%) completed all of
the survey questions
associated with the current
analyses. PSP participants
were assigned to one of six
categories for analyses:
communication officials
(e.g., 911 call center
operators/dispatchers),
correctional workers,
federal police (i.e., Royal
Canadian Mounted Police:
RCMP), firefighters,
municipal/provincial police,
and paramedics.

Major Themes Studied/
Definitions

Major Themes:
Stigmatizing attitudes
lead to improved
professional practice
with respect to the
persons with mental
illness in prison facilities
Perhaps such workshop
interventions ought to be
incorporated into the
training of novice prison
officers, especially in
prisons that provide
psychiatric care services,
such as outpatient clinics
and psychiatric wards.

48

Measurement/
Instrumentation
(focus group,
1:1, open-ended
survey)
Mental Health
Knowledge
Scale
Open Minds
Survey for
Workplace
Attitudes
Mental Health
Service Use
Questionnaire
The MHSUQ is
derived from the
76-item CAF-RMHSUQ
(Fikretoglu et
al., 2019a) and
consistent with
questions

Data
Analysis

Findings/
Themes

(MANCOV
A)
Multivariate
analysis of
covariance
was
conducted to
determine
whether
there were
significant
differences
in mean
mental
health.

Paramedics
reporting
high mental
health
knowledge
might
intuitively
suggest that
paramedics
will also
have a high
willingness
to engage in
helpseeking;
The current
results
demonstrate
d that
correctional
workers also

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
LOE: Level II
Strengths:
Supports the need
for correctional
staff mental health
education by
comparing to other
PSP.
First, a large,
representative
sample of
Canadian PSP was
identified in the
current study and
allowed for
comparisons
across public
safety occupations
rather than focused
attention to one

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

was collaboratively
designed by
researches from the
University of
Regina and the
Public Safety
Steering Committee
(PSSC) of the
Canadian Institute
for Public Safety
Research and
Treatment
(CIPSRT).

Design/ Method/
Sampling
(Grounded
Theory,
phenomenology,
Narrative…)

Sample/Setting (describe)

Major Themes Studied/
Definitions

49

Measurement/
Instrumentation
(focus group,
1:1, open-ended
survey)
regularly used in
Statistics
Canada surveys
to assess mental
health service
use. The
Cronbach’s α for
the MHSUQ
was α = 0.95 in
the current
sample.

Data
Analysis

Findings/
Themes

reported the
highest
mental
health
knowledge,
lowest
stigma, and
highest
intentions to
seek mental
health
services.

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
category.
Weaknesses:
Self-report via
online survey.
High potential of
bias.
Several PSP
agencies with
diverse population
settings.

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

50

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

Kois, L., Hill, K.,
Gonzales, L.,
Hunter, S., &
Chauhan, P. (2020).
Correctional Officer
Mental Health
Training: Analysis
of 52 U.S.
Jurisdictions. Crimi
nal Justice Policy
Review, 31(4), 555–
572.
https://doi.org/10.11
77/08874034198496
24
October 2017
through March 2018
data collected on
mental health

Qualitative
Study
The study was
designed to
determine the
amount of
mental health
training or inservice that is
provided to
correctional
staff at all 52
U. S.
Jurisdictions.

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)
Department of
Corrections (DOC)
in all 50 states, the
District of
Columbia, and the
Federal Bureau of
Prisons using
information
gathered from
respective websites
from October 2017
through March
2018.

Sample/Setting
(describe)

Major Themes Studied/
Definitions

For each jurisdiction,
we requested (a)
instruction method
(e.g., instructor
qualifications), (b)
hours of preservice
mental health
training, and (c) the
title of mental health
courses required

Major Themes:
Overall, it appears mental
health training comprises
a small portion of CO
training.
Research indicates CO
mental health training is
an important endeavor that
can help maintain safety
and security in jails and
prisons.
The next most frequent
course topics are general
psychoeducation (n = 24,
46.15%), special
populations (n = 12,

51

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)
Data were collected
via telephone and
email contacts with
administrative and
training staff and/or
Freedom of
Information Act
requests.
Two researchers, a
licensed clinical
psychologist and
clinical psychology
doctoral student,
independently
coded method of
instruction and
course title data.

Data
Analysis

Findings/
Themes

NVivo v.12
(2018)
software to
conduct
thematic
analyses
with our
qualitative
(instruction
method and
course title)
data.

With respect
to mental
health
training
duration, hour
requirements
range from
1.5
(Tennessee)
to 80
(Florida) hr of
instruction.
Diverse
Mental health
Training
requirements
among states.
Average

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
LOE: Level II
Strengths:
It appears that all
COs in the
jurisdictions
surveyed receive
some mental health
training, although
duration and
course content
varies.
Great similarities
in psychoeducation
requirements from
comparisons.
all jurisdictions
require some form
of mental health

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

training programs in
all 52 U.S.
Jurisdictions.

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)

Sample/Setting
(describe)

Major Themes Studied/
Definitions

23.08%), specific clinical
interventions (n = 7,
13.46%), institutional
procedure specific to
mental health (n = 6,
11.54%), and CO mental
health and self-care (n = 4,
7.69%).

52

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)

Data
Analysis

Findings/
Themes

Correctional
Officer MH
Training:
Across
jurisdictions,
COs are
required to
complete a
mean of 13.54
hr
Training
programs
most often
utilize mental
health
professionals
(n = 37,
71.15%) and
training
academy
personnel (n =

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
training, and many
requirements were
recommended by
Parker (2009):
Weaknesses:
These data were
collected from
October 2017
through March
2018, and the
requirements
reported here
might not be in
place at this time
COs serving in
individual jails
may receive
different or

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Citation

Theory/
Conceptual
Framework

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)

Sample/Setting
(describe)

Major Themes Studied/
Definitions

53

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)

Data
Analysis

Findings/
Themes

31, 59.62%)
for course
instruction.

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
additional training
within that state
(e.g., as reported
by Louisville
Metro staff,
personal
communication),
and these training
practices should be
documented in the
future

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

Christopher, M.,
Hunsinger, M.,
Goerling, L.,
Bowen, S., Rogers,
B., Gross, C.,
Dapolonia, E., &
Pruessner, J. (2018).
Mindfulness-based
resilience training to
reduce health risk,
stress reactivity, and
aggression among
law enforcement
officers: A
feasibility and
preliminary efficacy
trial. Psychiatry
Research, 264, 104–
115.

MixedMethodology:
Based on a
MindfulnessBased Stress
Reduction
(Kabat-Zinn,
1990)
framework,
MBRT was
delivered in
eight weekly
2-hour
sessions with
an extended
6-hour class
in the seventh
week.

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)
LEOs were
recruited from law
enforcement
agencies in a large
urban area and
surrounding metro
region in the
Pacific
Northwestern
United States
through emails,
fliers, and inperson
presentations

Sample/Setting
(describe)

Major Themes Studied/
Definitions

MBRT Group (N)
= 31

Major Themes:

NIC Group (N) =
30
Randomized (N) =
61

MBRT participants
endorsed a lower
composite E/CQ score
of responses assessing
the degree to which
they felt the
intervention would
improve job stress, job
performance, and
resilience.

54

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)
Several Measurements
were conducted.
Treatment expectancy
and credibility
Expectancy/Credibility
Questionnaire (E/CQ).
PROMIS® (v1.0)
short form versions
were used to assess
sleep disturbance (6
items), alcohol use (7
items), anxiety (6
items), and depression
(6 items).
7-item Concise Health
Risk Tracking Scale

Data Analysis

Pre-training
Post-training
Three-month
follow-up
showed
statistical
improvement
in knowledge
and self measurement
tests
conducted.

Findings/
Themes

Relative to
NIC, MBRT
participants
endorsed
improvements
in
psychological
health
outcomes
(burnout,
organizational
stress, and
sleep
disturbance
[trend-level
significance])
and potential
mechanisms
(psychologica
l flexibility

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
LOE: Level III
Strengths:
Results suggest
MBRT is feasible
and acceptable to
LEOs, evidenced
by meeting
benchmarks for
participant
enrollment (n =
61), acceptance of
randomization
(97%), class
attendance (79%),
and overall
attrition rate
(20%).

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

https://doi.org/10.10
16/j.psychres.2018.
03.059
Funding: Research
reported in this
publication was
supported by the
National Center for
Complementary &
Integrative Health
of the National
Institutes of Health
under Award
Number
R21AT008854. The
content is solely the
responsibility of the
authors and does not
necessarily
represent the official
views of the

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)

Sample/Setting
(describe)

Major Themes Studied/
Definitions

55

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)
(CHRT).
Police Stress
Questionnaire (PSQ)
The Oldenburg
Burnout Inventory
(OLBI)
The Five Facet
Mindfulness
(Questionnaire-Short
Form (FFMQ-SF)
The Acceptance and
Action QuestionnaireII (AAQ-II)

Data Analysis

Findings/
Themes

and nonreactivity).
This
replicates
previous MT
meta-analyses
of RCTs
across various
healthy and
clinical
populations

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
Weaknesses:
45% withdrew due
to a change in
work schedule
preventing them
from attending
MBRT sessions.
The enrollment
and attrition rates
are consistent with
previous MT
research among
high-stress cohorts,
including military
personnel.

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

National Institutes
of Health

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)

Sample/Setting
(describe)

Major Themes Studied/
Definitions

56

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)

Data Analysis

Findings/
Themes

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Citation

Theory/
Conceptual
Framework

Antony, J., Brar, R.,
Khan, P., Ghassemi,
M., Nincic, V.,
Sharpe, J., Straus,
S., & Tricco, A.
(2020).
Interventions for the
prevention and
management of
occupational stress
injury in first
responders: a rapid
overview of
reviews. Systematic
Reviews, 9(1), 1–
121.
https://doi.org/10.11
86/s13643-02001367-w

An overview
(i.e., a
synthesis of
systematic
review
findings) is an
effective
method to
systematically
gather,
appraise, and
summarize
existing
evidence on a
broad topic
that has been
well-studied,
and identify
gaps in the
research
efforts to date

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)
Systematic Review
of current research
and practice of
interventions for
first responders.
This overview
includes
systematic reviews
targeting first
responders or
frontline
community safety
personnel,
including police
officers,
firefighters,
correctional
officers, and
coroners, with a
focus on

Sample/Setting
(describe)

Major Themes Studied/
Definitions

Search strategy
was developed by
an information
specialist and peerreviewed by
another using the
Peer Review of
Electronic Search
Strategies
(PRESS) checklist
MEDLINE,
EMBASE,
PsycINFO,
CINAHL, Web of
Science, and
Cochrane Library
databases were
searched on
February 17, 2019,
for relevant
reviews.

Major Themes:
A total of 23 studies
reported rehabilitation
strategies and programs,
including 16 targeting
police officers, 6
targeting firefighters,
and 1 focusing on
correctional officers.
Interventions Focused
on the following:
Psychotherapy
Drug Therapy
Other Therapies
(EMDR) (Exposure
Therapy) (CISD) (BEP)
(ETCR) (CBT) (TRiM)
(Drug Therapy)

57

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)
AMSTAR 2 (A
Measurement Tool to
Assess Systematic
Reviews version 2.
Within the 14 reviews,
we identified 47
unique primary
studies, examining
both a relevant first
responder population
and an intervention
targeting OSI. The
majority of the studies
focused on police
(78.7%) and
firefighters (17%) with
only a small
percentage focusing on
correctional services
(4.3%)

Data Analysis

The 47 unique
primary studies
reporting any
intervention
are organized
by study
population.
Clinical
interventions
for diverse
groups show
promising
interventions
ranging from
EMDR to yoga
and show
clinical
statistically
improvements

Findings/
Themes

Findings will
serve as a
basis for the
MCSCS to
develop an
evidencebased strategy
to tackle OSI
in frontline
community
safety
personnel and
first
responders.
The suggested
next step
would be to
conduct a
systematic
review of
primary

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
LOE: Level IIII
Strengths:
Systemic Review
of several studies
across various
first-responder
agencies; including
correctional
officers.
The results from
this overview
suggest that
potentially
effective
prevention and
rehabilitation
strategies exist
targeting first

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

Funding:
Strategy for PatientOriented Research
(SPOR) Evidence
Alliance which is
supported by the
Canadian Institutes
of Health Research
(CIHR) under the
SPOR initiative and
the generosity of
partners from 41
public agencies and
organizations across
Canada.

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)
prevention and
rehabilitation of
OSI.

Sample/Setting
(describe)

(n = 1895 initial
search)
(n = 1377 after
duplicates
removed)
(n = 1393 records
screened)
(n = 121 Full-test
articles assessed
for eligibility)
(n = 14 unique
relevant studies
included)

Major Themes Studied/
Definitions

(Resilience Training)
(Stress Management)

58

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)

Data Analysis

for OSI in first
responders.

Findings/
Themes

studies to help
inform the
development
and
examination
of
interventions
targeted to
this
population.

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
responders at highrisk of developing
OSI.
Weaknesses:
Low number of
studies to evaluate
that were unique.
Only 4.3% of
studies were
relevant to target
population
(correctional
officers).

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

59

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Theory/
Conceptual
Framework

Citation

Comartin, E., Wells,
K., Zacharias, A., &
Kubiak, S. (2020).
The Use of the
Crisis Intervention
Team (CIT) Model
for Corrections
Officers: Reducing
Incidents within a
County Jail. The
Prison Journal
(Philadelphia,
Pa.), 100(5), 581–
602.
https://doi.org/10.11
77/00328855209563
34

An overview
(i.e., a
synthesis of
systematic
review
findings) is an
effective
method to
systematically
gather,
appraise, and
summarize
existing
evidence on a
broad topic
that has been
well-studied,
and identify
gaps in the
research

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)
This study
investigated the
use of CIT in a
county jail in a
large metropolitan
area in the
Midwest. The
county is home to
1.2million
individuals (U.S.
Census Bureau,
2016).
Eight, 8-h sessions
were held between
May and July of
2017 by a certified
CIT trainer who
adapted the
training to the

Sample/Setting
(describe)

Major Themes Studied/
Definitions

Three data sources
were used to assess
CO knowledge,
attitudes, and
behavioral changes.
Knowledge and
attitude changes were
assessed through two
sources: (1) pre/post
surveys for all COs
who took the training
and (2) pre/ postinterviews with a
stratified sample of
ten COs.
Administrative data
in the form of officer
reports were used to
assess whether CIT
training impacted
COs’ behavior

Major Themes:
Two out of three COs
(67%, 6/9) exhibited a
positive change in
overall perception of
mental health. COs
showed increased
understanding for
medication effects on
behavior along with
greater understanding of
why individuals might
not be able to control
their behaviors.

60

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)

Data Analysis

Findings/
Themes

Overall, 255 (83.3%)
were successfully
matched. Some
questions were reverse
coded, with a positive
reported mean change
score meaning that
COs used more
appropriate deescalation techniques
or their feelings
toward individuals
with mental illness
became less
stigmatizing and more
understanding of their
needs. Each question
on the instrument was
assessed individually
using paired samples t-

Of the 255
COs matched
on the pre/postsurvey
instruments,
the majority
were male
(73.3%,
n=187). The
average years
spent working
in the field was
12.2 years
(SD=9.7), and
ranged from
zero to 45
years. At presurvey, 70.1%
(n=178) agreed
that they had a

Major
findings from
this
exploratory
study showed
that CIT
training had a
positive
impact on
COs and their
experiences
with SMIrelated
situations.
COs exhibited
overall
positive
changes in
their
knowledge of

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
LOE: Level II
Strengths:
Improved mental
health perceptions
of COs. Improved
mental health
stigma.
Positive qualitative
feedback from
intervention for
CO staff.

Weaknesses:
To date, this is the
first study to assess
the use and

CIT-Y- Crisis Intervention Tool- Youth County A- urban county in the Southwest area of the state and has a population just above 200,000. County B- large metropolitan region with population over 1
million in the Southeast area of the State of Baltimore. IRR- inter-rater reliability. SD- Standard Deviation, FERPA-Family Educational Rights and Privacy Act of 1974. DV-Dependent Variable. IVIndependent Variable. CO: Correctional officer working in a jail, detention center, or prison. Wardens: executive manager over jail/prison population and staff. CIT: crisis intervention training. IBS
SPSS Version 25: Statistics is the world's leading statistical software used to solve business and research problems by means of ad-hoc analysis, hypothesis testing, and predictive analytics. CIT: Crisis
Intervention, ASU: Administrative Control Unit where those who pose a threat to others or to the orderly operation of a correctional facility are placed. MHU: Mental health unit designated to assist all
incarcerated males with severe mental health needs. TSU: that serves incarcerated males who need intensive medical care. DV: Dependent Variable, IV: Independent Variable, CV: Control Variable.
MHHF: Ministry of Health to the Health Funds, HMO: Israeli Health Maintenance Organizations, 6- Day Workshop: 48 hr spread over 2 weeks. PW: Psychiatric Wards, V1: Stigmatization, V2:
Perceived Knowledge, V3: Negative feelings, V4: Positive Feelings, V5: Perceived ability to manage interaction. SD: Standard Deviation. N: Sample Size 83 Israeli Correctional Officers. M: Men: 60
W: Women: 20. CIT = crisis intervention team; MI = mental illnesses; ANCOVA = analysis of covariance. aPaired t test conducted on CIT pre- and postdata. b ANCOVA utilized to test differences
between post-CIT and non-CIT data; pre-CIT and non-CIT data are not presented in this table. COs: Correctional Officers. MI: Mental Illness. CIPSRT: Canadian Institute of Research and Treatment,
PSSC: Public Safety Personnel, MAKS: The Mental Health Knowledge Scale, RCMP: Royal Canadian Mounted Police, MHSUQ: Mental Health Service Use Questionnaire, MANCOVA:
Multivariate analysis of covariance. IMI: Individuals with Mental Illness, COs: Correctional Officers, CIT: Crisis Intervention Training, DOC: Department of Corrections, MHP: Mental Health
Professionals, NVivo v.12: Software to conduct statistical data analysis. LEO: Law Enforcement Officers, MBRT: Mindfulness-Based Resilience Training; NIC: no intervention control, AAQ-II: The
Acceptance and Action Questionnaire-II, (FFMQ-SF): Questionnaire-Short Form: The Five Facet Mindfulness, (OLBI): The Oldenburg Burnout Inventory OSI: Occupational Stress Injury, EMS
emergency medical services, PTSD: post-traumatic stress disorder, RCT: randomized controlled trial, TRiM: trauma risk management, EMDR: Eye movement desensitization and reprocessing, BEP:
brief eclectic psychotherapy, CISD: critical incident stress debriefing, NR: not reported, NRCT: non-randomized controlled trial, CISD: Critical incident stress debriefing. CIT: Crisis Intervention
Training CO: Correctional Officer SD: Standard Deviation Pre/Post-Instrument: The same survey instrument was given to all COs immediately before and after the 8-h training session. The survey
asked for their gender (male/female) and the number of years of service. BOS: Behavioral Outcome Scale

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Citation

Theory/
Conceptual
Framework
efforts to date

Design/ Method/
Sampling
(Grounded Theory,
phenomenology,
Narrative…)
correctional
setting. The
training program
covered various
mental health
diagnoses
(schizophrenia, bipolar, etc.) and
symptomology, as
well as information
about psychotropic
medications and
their side effects.
Suicide in
correctional
settings was also a
training topic.

Sample/Setting
(describe)

Major Themes Studied/
Definitions

61

Measurement/
Instrumentation
(focus group, 1:1,
open-ended survey)
tests. Total scores for
each scale are also
presented; however,
these should be
interpreted with
caution due to low
reliability scores on
the BOS (pre=.26,
post=.40) and
attributions scale
(pre=.34, post=.25;
Officer Efficacy
(pre=.85, post=.85).

Data Analysis

strong desire to
take the
training, and
96.9% (n=246)
believed that
mental health
issues were a
serious
problem for
law
enforcement.
At post-survey,
both of these
proportions
had increased
(desire=89.7%,
n=226; and
serious
problem=98.0
%, n=249)

Findings/
Themes

mental
illnesses, as
well as in
their attitudes
toward
individuals
with SMI.

Level/Quality of
Evidence;
Decision for
practice/
application to
practice/
Generalization
impacts of CIT in a
jail setting. And
similar to the
recent evaluation
study of CIT
training in prison
(Canada et al.,
2020), there were
similar positive
outcomes

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

62

Appendix B
Author
Year
LOE
Platform
Web-based
Telehealth
In-person
Methods
Counseling/emotional support
Patient education
Patient surveys
Provider training/education
Self-paced learning modules

Kubiak

2019
2-RCT

DeHart
2019
1-QE

X
X
X
X
X

Measurement Tools for Outcomes

Attitudes Toward Disorder and non-Disordered
Behavioral Outcome Scale (BOS)
Social Distance Scale
Training Duration (Total Hours)
Mental Health Knowledge Scale
Pre-Post Test
Surveys
Use of Force Incidents

X

X
X
X
X

Kois
2020
1-SR

Krakauer
2020
1-SR

X

X

X

X

X
X

X

X

X

X
X

Canada
2021
1-QE

Melnikov
2017
1-QE

Mcneeley
2021
1-RCT

X

X

X

X
X
X

X
X

<<< Outcomes >>>

Variables

Mindfulness Based Resilience Scale
Special Populations
Crisis Intervention Training
Perceived Knowledge
Psychoeducation
Mental Health Knowledge

Anthony Comartin Christopher
2020
2020
2018
1-SR
1-SR
1-RCT
<<< Interventions >>>

⇑

⇑

X

X
X

X
X

X

X

⇑

⇑
⇑

X
X

⇑
⇑
⇑
X

X
X

⇑

⇑

⇑
⇑

⇑

⇑
⇑
⇑

X
X
X

X

X
X

⇑
X

X
X

⇑

X

X
X
X

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

63

Appendix C

Ajzen, (2011)

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

64

Appendix D

(Buckwalter et al., 2017)

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

65

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Appendix F

66

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

67

Module One: What is Mental Health (DeHart & Iachini, 2019)

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

Appendix G

Mental Health Knowledge
Schedule (MAKS) (Thornicroft et al., 2015)

68

CORRECTIONAL OFFICER MENTAL HEALTH TRAINING

69

Appendix H

10-Item Trauma Quiz (DeHart & Iachini, 2019)