Examining the Effects of Structured and Non-Structured Therapeutic Activity Programming in a Forensic Mental Health Treatment Facility

Abstract

Examining the Effects of Structured and Non-Structured Therapeutic Activity Programming in a Forensic Mental Health Treatment Facility: North Florida Evaluation and Treatment Center (NFETC) is an evaluation and treatment center for individuals with mental illnesses who are involved in the criminal justice system. NFETC offers services to adult males who are either incompetent to proceed to trial or have been judged to be not guilty by reason of insanity. In 2005, DCF implemented a system of structured programming in their state forensic psychiatric hospitals. Resident programming went from a referral based activity program (approximately 6 hours per week for each resident) to a structured activity program (approximately 24 hours per week for each resident). In the previous system, a resident's involvement in the referral based activity program was initiated by the residents' counselor and based on the resident's interests. In the current structured TAP program, all residents now average 24 hours per week of activity involvement. Resident attendance is mandatory for those well enough to attend programming. Despite the importance decreasing length of stay (LOS) has on state legal and criminal systems, little research exists on the role recently implemented structured programming plays in resident LOS. This study contains Retrospective Quantitative analyses on the relationships between facility programming and resident demographics, criminal charges, mental health diagnoses, LOS, and attendance and participation rates; as well as Qualitative analyses on program offerings and staff impressions of the current structured programming at NFETC. The results suggest that, despite many differences between the samples of residents receiving the two programs, there is a therapeutic value to the activity programs offered regardless of the program setting. With consideration of staff perspectives and quantitative findings, the current program can be restructured to provide additional benefit. The benefits of activity programming in general were evident in the results of the analyses run separately for each program. Within the Referral based programming, residents with lower participation levels had an increased LOS. Within the structured TAP programming, residents with lower participation levels had an increased LOS and residents with high participation levels had a decreased LOS. These results indicate that involvement in therapeutic activities, regardless of programming format, may be beneficial in decreasing LOS. The Qualitative staff interview component of the current research provided additional insight into issues related to the prior and current program offerings at NFETC, much of which were supported by the Quantitative data. Qualitative findings included staff impressions of both programs as well as issues regarding LOS, value of therapeutic activities, accessibility, attendance, resident choice, internal motivation, safety, program content, and resident participation. The issues, if addressed, have the potential to streamline the program at NFETC into a more effective and useful therapeutic element. These Quantitative and Qualitative findings should serve as suggestions for a program revamping at NFETC.