Key Takeaways
Extended Takeaways
- Recent criminal legal involvement at entry was a strong marker for early treatment disruption: 13 of 39 participants (33%) with CLI at baseline had later CLI versus 39 of 335 participants (12%) without baseline CLI, and dropout due to incarceration was 18% versus 2%.
- Because 14 of the 16 incarceration-related dropouts (88%) occurred within the first 6 months of treatment, clinicians may need intensified monitoring and care coordination immediately after enrollment for patients with recent CLI.
- Lower educational attainment and longer duration of untreated psychosis were linked to CLI before treatment, with participants with a longer DUP significantly more likely to have CLI (16%) than those with a shorter DUP (6%), supporting screening for legal vulnerability when FEP presentation has been prolonged.
- Substance use findings were most clinically useful when focused on current use rather than lifetime diagnosis: in multivariable models, cannabis use in the month before baseline was the only baseline predictor that remained significant for later CLI.
- Persistent symptom burden mattered after treatment entry: when longitudinal clinical variables were modeled together, only average excitement symptoms remained associated with follow-up CLI (B = .20, SE = .09, p = .02, OR = 1.22, 95% CI = 1.03–1.44), highlighting hostility, impulsivity, and uncooperativeness as practical targets for risk reduction.
- NAVIGATE did not reduce CLI relative to Community Care in this sample, with similar follow-up rates (13.88% and 13.61%) and no adjusted difference (B = .02, SE = .38, p = .96, OR = 1.02, 95% CI = 0.55–1.87), suggesting standard Coordinated Specialty Care may need added criminogenic-risk interventions for patients at highest risk.
