# Integrated Treatment Adherence Program for Bipolar Disorder at the Time of Prison Release

> **NIH NIH R34** · BROWN UNIVERSITY · 2020 · $242,709

## Abstract

Abstract:
Bipolar disorder (BD) is a serious, disabling, and highly recurrent illness that is disproportionately represented
in the criminal justice system. BD increases risk for several adverse outcomes for prisoners, including mood
instability, suicide attempts, substance use relapse, and high rates of repeat incarceration. Despite these
serious negative sequelae, up to 70% of prisoners with BD do not receive mental health treatment upon prison
release. Lack of engagement in ongoing mental health treatment for BD upon community re-entry represents
one potent factor that perpetuates risk for adverse outcomes, and consequences of untreated BD (e.g.,
impulsivity, substance use) may greatly exacerbate difficulties in establishing stable living conditions (e.g.,
adequate housing, legal employment) at community re-entry. Thus, there is a critical need for interventions to
facilitate engagement with treatment for BD during this vulnerable transition. The primary aim of this R34 pilot
effectiveness trial (RFA-MH-17-612) is to develop and establish the feasibility, acceptability, and potential for
future uptake of the Community treatment Adherence at Re-Entry (CARE) program. CARE is an innovative
intervention that combines evidence-based cognitive-behavioral, family, and telephone outreach strategies to
promote treatment engagement and improve clinical outcomes for prisoners with BD during the period of
community re-entry. Informed by our pilot work, CARE will include 3 individual and 1 family session in prison,
followed by 11 brief telephone contacts for up to 6 months post-release. Given its moderate intensity,
adjunctive nature, use of community mental health counselors, and telephone administration, CARE has been
designed with an eye toward community implementation. Its mechanisms of action (i.e., increasing values-
action consistency, enhancing social supports, and service linkage, all to promote treatment engagement,
thereby improving clinical outcomes) are further well matched to the practical and clinical needs of re-entering
individuals. The development phase of the study will result in a treatment manual, training manual, and fidelity
scales, to be tested in an open trial of 12 prisoners with BD nearing prison release. The pilot study will examine
feasibility and acceptability of the proposed recruitment methods, research design, intervention, and training
program by randomizing 40 prisoners with BD nearing prison release to treatment as usual (TAU), enhanced
with monitoring and emergency referral, or to enhanced TAU plus CARE. The primary outcome will be mood
symptoms in the 6 months post-release. Secondary outcomes include: suicidal ideation/behaviors, substance
use, re-arrest rates, and employment and housing stability. We will also explore differential engagement of
CARE’s purported mechanisms of action. To our knowledge, this proposal represents the first attempt to
develop and pilot a targeted transitional interventional for BD among pri...

## Key facts

- **NIH application ID:** 9982131
- **Project number:** 5R34MH117198-03
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** LAUREN M WEINSTOCK
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $242,709
- **Award type:** 5
- **Project period:** 2018-09-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9982131

## Citation

> US National Institutes of Health, RePORTER application 9982131, Integrated Treatment Adherence Program for Bipolar Disorder at the Time of Prison Release (5R34MH117198-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9982131. Licensed CC0.

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