Evolving Roles of Nonprofit Organizations in Public Service Delivery: Evidence from a Police–Nonprofit Collaboration in Waco, Texas

Law enforcer or social worker? Exploration of the role of police in responding to persons with mental illness

Situations involving people who, due to a mental illness, are unable to care for themselves or pose a threat to others are typically handled by the police. Dealing with people experiencing mental illness who are in crisis is inherently challenging work and police officers are often considered to be unprepared and unsupported. When resolving such encounters, police officers have a number of options, including formal dispositions, such as arrest or involuntary hospitalisation, and informal dispositions, such as calming the person down or ignoring the situation. Given that there is no single framework which can be applied to all encounters between law enforcement personnel and people experiencing mental illness, police officers are necessarily afforded some discretion when resolving these situations. Much research has been conducted regarding the factors which influence outcomes following police encounters with people experiencing mental illness. Among these are the policies and procedures which operate in different police organisations, the availability of community mental health resources, whether the encounter was invoked by the police or the public, and the characteristics of the offender and the police officers involved. The broad aims of this thesis were to (i) describe police officers’ perceptions regarding their experiences dealing with people experiencing mental illness in Victoria, Australia, (ii) describe police officers’ attitudes toward working with people experiencing mental illness, and (iii) investigate the predictive capacity of police officers’ attitudes regarding mental illness related to their preferred means for handling cases involving people experiencing mental illness. Three main studies are reported. The first is an investigation of the current interface between police officers in Victoria and people experiencing mental illness. Based on survey data, findings related to the frequency of police contacts, the types of encounters, the signs and symptoms associated with mental illness and the challenges faced by police officers when performing these duties are reported. The second study is an examination of police officers’ attitudes toward people experiencing mental illness. Participants completed a survey measuring their attitudes and the results were then analysed using Principal Components Analysis (PCA). Analyses revealed four distinct themes underlying the attitudes of surveyed police officers. Broadly speaking, the officers held positive attitudes toward people experiencing mental illness, but negative attitudes about the system that cared for them. Multivariate analyses revealed that the measured attitudes were not associated with demographic characteristics. The third study explored factors which are related to police officers’ preferred means for resolving encounters with people experiencing mental illness. Participants watched one of three vignettes depicting an encounter with a man who might be mentally ill, and were asked to speculate on how they would “likely” and “ideally” resolve the encounter. Each of the vignettes differed according to the apparent severity of the man’s psychiatric symptoms. Discriminant function analysis revealed that the outcomes chosen by officers were related to both the severity of the man’s psychiatric symptoms and the officers’ attitudes toward people experiencing mental illness. These findings highlight the important role played by police officers in managing people in the community who experience mental illness. Some police officers surveyed felt unprepared for this role and many perceived that there was inadequate cooperation from mental health services. Given these challenges, it was important to begin to understand police officers’ attitudes to their work involving people experiencing mental illness. Following quasi-experimental analysis, these attitudes, among with other situational variables, were found to relate to outcomes chosen by police officers following their encounters with people experiencing mental illness.

Children and adolescents are increasingly being prescribed psychotropic medications to address mental health needs. With the difficulty in accessing child and adolescent psychiatrists, primary care providers are often tasked with initiating and managing these medication regimens. The standard of care around psychotropic prescribing in primary care often falls short of practice parameters and prescribing guidelines due to a number of factors including lack of training, time, and payment reimbursement for these services. Pediatric psychologists embedded in the primary care medical home are well positioned to undertake collaborative medication-related roles as part of the standard of care in these settings. This commentary highlights the rationale for pediatric psychologists to undertake collaborative roles in medication management, outlines what collaborative roles may look like in practice, and discusses implications for training and research. A case example is also included to highlight a collaborative consultation around medication management in primary care.

Applying Procedural Justice Theory to Law Enforcement's Response to Persons With Mental Illness

CAHOOTS, a thirty-year-old Oregon program, has reduced calls to police and saved money. Now it's going national.

Sleep disorders often remain undiagnosed. Untreated sleep disorders among police officers may adversely affect their health and safety and pose a risk to the public. To quantify associations between sleep disorder risk and self-reported health, safety, and performance outcomes in police officers. Cross-sectional and prospective cohort study of North American police officers participating in either an online or an on-site screening (n=4957) and monthly follow-up surveys (n=3545 officers representing 15,735 person-months) between July 2005 and December 2007. A total of 3693 officers in the United States and Canada participated in the online screening survey, and 1264 officers from a municipal police department and a state police department participated in the on-site survey. Comorbid health conditions (cross-sectional); performance and safety outcomes (prospective). Of the 4957 participants, 40.4% screened positive for at least 1 sleep disorder, most of whom had not been diagnosed previously. Of the total cohort, 1666 (33.6%) screened positive for obstructive sleep apnea, 281 (6.5%) for moderate to severe insomnia, 269 (5.4%) for shift work disorder (14.5% of those who worked the night shift). Of the 4608 participants who completed the sleepiness scale, 1312 (28.5%) reported excessive sleepiness. Of the total cohort, 1294 (26.1%) reported falling asleep while driving at least 1 time a month. Respondents who screened positive for obstructive sleep apnea or any sleep disorder had an increased prevalence of reported physical and mental health conditions, including diabetes, depression, and cardiovascular disease. An analysis of up to 2 years of monthly follow-up surveys showed that those respondents who screened positive for a sleep disorder vs those who did not had a higher rate of reporting that they had made a serious administrative error (17.9% vs 12.7%; adjusted odds ratio [OR], 1.43 [95% CI, 1.23-1.67]); of falling asleep while driving (14.4% vs 9.2%; adjusted OR, 1.51 [95% CI, 1.20-1.90]); of making an error or safety violation attributed to fatigue (23.7% vs 15.5%; adjusted OR, 1.63 [95% CI, 1.43-1.85]); and of exhibiting other adverse work-related outcomes including uncontrolled anger toward suspects (34.1% vs 28.5%; adjusted OR, 1.25 [95% CI, 1.09-1.43]), absenteeism (26.0% vs 20.9%; adjusted OR, 1.23 [95% CI, 1.08-1.40]), and falling asleep during meetings (14.1% vs 7.0%; adjusted OR, 1.95 [95% CI, 1.52-2.52]). Among a group of North American police officers, sleep disorders were common and were significantly associated with increased risk of self-reported adverse health, performance, and safety outcomes.

INTRODUCTION: Response to student mental health crises involves interdisciplinary school-community teams, which can include police officers. This paper presents the first systematic review of literature on how police address mental health in school settings. Results have implications for school nurses interacting with responding police. How are police involved in responding to student mental health needs in elementary and secondary schools? Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, six articles met criteria for inclusion in this review. Two themes were identified: (1) descriptions of roles of police in schools and (2) studies presenting programmes or models of police engagement. The most common use of police in schools is through the School Resource Officer model. There are very few studies examining police involvement in mental health response in schools and little data available on whether prevailing models are effective. We are therefore unable to ascertain what impact school police have in responding to mental health crises or the extent to which they interact with school nurses. Understanding mental health crisis responses in schools can inform policy, practice, research and education for police and school providers, including nurses.

PurposeThe purpose of this paper is to examine the important role of cross-sector partnerships and collaboration in global emergency management, relevant in situations such as the ongoing COVID-19 pandemic and grand global challenges.Design/methodology/approachThe paper utilizes exploratory historical methods and examines cross-sector partnerships from three key emerging markets – Pakistan, Turkey and Nigeria. The context of the emerging markets is important given the institutional fragility such markets encountered.FindingsThe authors offer a conceptual discussion that explicates the vital role of such partnerships in global emergencies. The authors also highlight the instrumental role of adaptive learning in cross-sector partnerships, which can help multiple stakeholders create and deliver value in response to an emergency like a global health pandemic caused by the COVID-19. Along with the conceptual discussion, the authors further offer practical examples of cross-sector partnerships in emerging economies of Pakistan, Turkey, and Nigeria – undertaken in response to the recent pandemic – emphasizing that such partnerships are crucial to mitigate the emergencies and their consequences on society. Finally, this paper offers theoretical and practical implications for cross-sector collaboration and partnerships in response to the global crisis.Research limitations/implicationsThis research is limited to emerging markets context and further research is needed on this important topic.Originality/valueThis paper is relevant given the current global pandemic caused by the COVID-19. There are relatively limited research studies on the cross-sector partnerships and their role in global emergencies, grand challenges and global crisis, thus this paper offers important insights on cross-sector partnerships and their value creation in global crisis situations.

SUMMARY Collaborations between businesses and nonprofit organizations are becoming more prevalent, important, and complicated. Marketing plays an increasingly significant role in these cross-sector relationships. This article will first set forth a framework for understanding alliances between companies and nonprofits. It will then examime how such cross-sector collaborations relate to four strategic and interrelated marketing areas: institutional marketing, cause-related marketing, market development, and internal organizational marketing.

Despite the impact of stress on both physical and psychological health, very few people seek professional support in managing their stress. Potential targets for non-clinical interventions to aid in stress management are therefore a timely area to explore. Emerging research has found that holding the belief that stress can have enhancing consequences–stress mindset–can have a positive effect on physical and psychological wellbeing, coping behaviours, affective outcomes, and performance in response to laboratory stressor tasks and ecological stress over short periods of time. Stress mindset has also been found to be malleable through brief multimedia interventions and may therefore be a suitable target for non-clinical interventions to aid in stress management. Mindsets are conceptualised as an individual’s beliefs about whether fundamental attributes are fixed or malleable; however, the existing measure of stress mindset diverges from this conceptualisation, operationalising stress mindset as strictly enhancing or strictly debilitating. There is also a lack of data explaining the mechanisms through which stress mindsets influence these stress-related outcomes. Further, interventions have only been evaluated in the context of responses to laboratory stressors and ecological stressors over a few days. The program of research presented in this thesis has three overarching aims. The first aim is to develop and evaluate a model that explains the mechanisms through which stress mindset influences stress-related outcomes and to evaluate whether the structure of the proposed model holds in a different context and sample. The second aim is to advance measurement of stress mindset through the development and validation of a measure of stress mindset that is theoretically-consistent. The final aim is to develop and evaluate the effect of a novel intervention on individuals’ stress mindset, and on stress-related outcomes while individuals experience ecological stress over a two-week period. As a thesis by publication, four papers report the four studies that comprise this program of research. Study 1 aimed to validate the stress control mindset measure (SCMM) across samples from Australia (n = 218) and the United Kingdom (n = 214). Confirmatory factor analyses indicated a consistent four-factor structure and measurement invariance across samples. Construct validity regarding conceptually-related measures and reliability was also supported across both samples. Stepwise regression analyses also indicated that the SCMM exhibited incremental validity, accounting for significantly more variance in health and wellbeing outcomes than the stress mindset measure. The SCMM is therefore a valid and reliable measure with good psychometric properties that addresses the divergence in measurement and theory of stress mindset. To develop an understanding of the mechanisms through which stress mindset may influence health and performance outcomes, Study 2 developed and tested a novel stress beliefs model. Undergraduate students (n = 218) completed study measures in a research laboratory. Findings indicate that behaviours with the goal of proactively meeting demands under stress and perceived somatic symptoms are important mediators of the effect of stress mindset on health- and performance-related outcomes. Study 3 aimed to test the stress beliefs model in a sample of police officers, replicating and extending upon Study 1 and using a Bayesian analytic technique to provide updated estimates of model parameters. Police officers (n = 134) completed study measures in an online survey. Findings supported model predictions, with behaviours aimed at proactively meeting demands and perceived somatic symptoms mediating the effects of stress mindsets on health-related outcomes. The findings from these studies provide formative data which can inform the development of future interventions aiming to encourage more adaptive responses to stress. Study 4 aimed to develop and test of a novel imagery intervention to change stress mindset. The study adopted a pre-registered randomized placebo-controlled trial design. University students (n = 150) attended a research laboratory twice over two weeks, receiving the intervention or placebo in Session 1, and completing measures in both sessions. Students’ academic performance data was collected from university records. Large-sized differences in stress mindset were observed in intervention group participants immediately following the intervention and at the two-week follow-up relative to controls. However, there were no effects of the intervention for the pre-registered analyses. Further theory guided analyses robust effects of the intervention on perceived distress, positive and negative affect, proactive behavior, and academic performance at the follow-up in individuals with high baseline perceived stress. Overall, the findings of this research program make an important contribution to our knowledge of stress mindset and provide important theoretical and practical implications. The research provides advances in measurement with the new measure of stress mindset, the SCMM, addressing a prior divergence in theory and measurement and accounting for more variance in health and wellbeing outcomes than the existing measure. The development and testing of the stress beliefs model in students and police officers provides foundational theory for understanding how stress mindsets influence health and performance, identifying that proactive coping behaviour under stress and perceptions of somatic symptoms are mediators in this process. The final study developed and tested a novel mental imagery intervention, and findings indicate that the intervention is a promising approach for changing individuals’ stress mindset and that changing stress mindset can have beneficial effects on coping with ecological stressors.

COMMUNITY-BASED AND RESTORATIVE-JUSTICE INTERVENTIONS TO REDUCE OVER-POLICING

Background School reforms requiring collaborations spanning multiple sectors are increasing in prevalence, but extant research has primarily focused only upon cross-sector partnerships involving education and social services. College and career readiness (CCR) reforms, such as the one highlighted in this study, are also often intrinsically cross-sectoral in nature. It is necessary to understand how such complex collaborations are developed and maintained. Purpose: This study examined how cross-sector collaboration has shaped the development and implementation of district-wide high school career academies in a large urban school district. Research Design We applied case-study methodology to examine a mature cross-sector collaboration that guides and supports the district's career academy reforms. A meta-framework concerning cross-sector collaboration—developed by Bryson, Crosby, and Stone—supported our design, data collection, and analysis. Conclusions Findings disclose a complex system of structures and processes to support reform implementation and illuminate the role and nature of cross-sector collaborations. This study provides an initial step toward understanding the elements, processes, and leadership required to develop and sustain cross-sector CCR reforms. The findings hold relevance for practitioners (e.g., how to develop and strengthen such complex reforms), community partners, and researchers (e.g., theory-building regarding reform-supporting elements and their interactions).

1.1 Objective: To review the literature and trusted scientific websites on studies about Collaborative role education and its application in postgraduate psychiatric training. 1.2 Methods: Medline literature and scientific websites were searched. The data selected were those discussing collaboration care efficacy, collaborative role competency and the application of adult education theory principles through Interprofessional education (IPE). The results reported are those obtained using appropriate techniques and published in reputable journals or on trusted scientific websites. Information relevant to mental health and postgraduate psychiatric training was selected for inclusion. 1.3 Results: Collaborative role is one of the seven core roles (CanMEDS) that define essential physician competencies. Collaborative care and IPE were efficacious in improving cost efficiency, patient safety, health professionals’ satisfaction and patient outcomes in different populations. According to a 2005 survey, the majority of mental health professionals in Canada support but do not presently offer formal pre-licensure, post-licensure, or continuing IPE involving collaborative mental health care. 1.4 Conclusion: Despite some challenges, IPE is a very worthy way to build collaborative role competency in postgraduate psychiatry trainees.

Throughout the United States, police officers experience cumulative stress and their mental health-related concerns often remain unaddressed. Recently, police departments have begun to offer more mental health support resources in an attempt to mitigate this issue. However, the underutilization of such support is a serious problem. The overall goal of this dissertation is to develop a grounded theory of mental health communication in law enforcement. Employing a constructivist grounded theory approach, data were collected in two sequential phases. Phase one involved 48 in-depth semi-structured interviews with active and retired police officers to examine how the messages police officers receive from society, police departments, and interpersonal relationships shape their perceptions of mental health. Guided by the findings in phase one, a one-time anonymous online survey was completed by 58 additional active police officers to further explore their preferences for mental health-related communication in receiving support and information about available resources in phase two. The theory explains and illustrates how two potential routes, involving multiple layers of influence, can shape police officers' views of mental health and support seeking. Theoretically, this dissertation extends our current understanding of disclosure decisions and the role of communication in officers' willingness to seek mental health support. The grounded theory presented in this dissertation also yields several practical implications for policymakers, department leadership, and families of vi police officers. Moreover, the grounded theory provides a foundation for building a more comprehensive explanation of mental health communication in first responder professions.

Despite the presence of a robust healthcare system, racial disparity and social inequalities remain prevalent in the United States. These disparities in healthcare are persistent challenges, disproportionately affecting marginalized communities and contributing to unequal health outcomes. This study investigates the role of cross-sector collaboration among healthcare providers, public health agencies, community-based organizations, and policy makers in mitigating these disparities. Using a mixed-methods approach that includes case studies, stakeholder interviews, and data analysis from collaborative health initiatives across five urban regions, the research identifies key drivers of success in cross-sector partnerships. Findings highlight the importance of community engagement, shared data systems, culturally competent care models, and sustained funding in reducing barriers to access and improving health equity. The study concludes that cross-sector collaboration is not only essential but also highly effective in addressing the root causes of health disparities, and it offers policy recommendations to support the development and scalability of such partnerships nationwide.