Forging New Paths: First-of-its-Kind Intervention Aims to Help People with Serious Mental Illness
CORE TEAM
Amy Blank Wilson (PI), Natalie Bonfine (Northeast Ohio Medical University), Jonathan Phillips (University of Minnesota), Jamie Swaine (UNC Center for Excellence in Community Mental Health), Faith Scanlon (Massachusetts General Hospital/Harvard Medical School), Anna Parisi (George Mason University), Caroline Ginley (UNC Center for Excellence in Community Mental Health), Robert Morgan (Southern Illinois University Carbondale)
Nearly 1.8 million people in the United States are incarcerated according to a 2025 Statista estimate.
Of this population, a disproportionate share are individuals with serious mental illness (SMI).
Yet interventions aimed at addressing this imbalance are lacking. Professor Amy Blank Wilson at the University of North Carolina at Chapel Hill School of Social Work is seeking to change that.
Wilson’s interest in the intersection of mental health and the criminal legal system is what drew her to social work research, and she has a wealth of experience developing and conducting interventions in this area.
With a team of researchers, Wilson developed the Targeted Service Delivery Approach (TSDA), which entails tailoring existing evidence-based correctional interventions to meet the needs of people with SMI. A 2023 trial of TSDA demonstrated its effectiveness in prisons and now Wilson is expanding her intervention research to reach beyond the prison walls.
Forging new paths in community mental health
Wilson’s latest project, Forging New Paths (FNP), is the first intervention for justice-involved individuals with SMI designed to be delivered not in prisons, but in the community mental health environment.
This setting greatly expands the number of people who can benefit from the intervention, as about half the people with SMI receiving treatment in community mental health centers have had criminal legal system involvement.
Furthermore, introducing the intervention in community mental health centers could have important impacts even beyond reducing recidivism among individuals with SMI. Wilson believes FNP has the potential to keep people from entering the criminal justice system entirely.
“When we’re successful — and I’m not going to say ‘if’ — in developing models that engage people in meaningful ways in community mental health systems, then we start to inform prevention,” Wilson said. “This would increase the number of services actively working to deflect people with serious mental illness from criminal legal system involvement by directing them toward community-based treatment services that address previously unmet needs.”
What is FNP? Content, structure and delivery
FNP applies the therapeutic principles of TSDA to cognitive behavioral therapy (CBT) techniques and social learning methods, offering an evidence-based and contextually relevant treatment to help people with SMI reduce their risk of criminal legal system involvement.
The intervention works by targeting traits and behaviors that existing research has identified as risk factors for involvement with the criminal legal system, which include aggression, impulsivity, and difficulties with interpersonal problem solving. While other interventions that target these risk factors are generally designed for the broader prison population, FNP is the first to be tailored for use in a community mental health setting and specifically for individuals with SMI.
The intervention is group-based and delivered by two facilitators. It consists of five treatment modules: Forging New Paths Together; Handling Emotions in Stressful Situations; Growing Positive Attitudes and Relationships; Navigating Difficult Situations; and Mental Health Recovery: Taking Care of Myself.
Sessions are held for an hour once a week in a hybrid format that allows participants the option of attending virtually or in person. The group setting enables participants to learn from one another and practice new skills together.
Designing FNP: User-centered design and the rapid iteration model
The innovative design process Wilson and her team used to create FNP was key in ensuring its real-world usability for individuals with SMI in community service settings.
Much mental health research focuses on adapting existing evidence-based interventions to treatment populations and settings for which they were not initially designed, which can challenge essential elements of the underlying interventions.
To avoid this limitation, Wilson and her team took a different approach, following the user-centered design principles developed by researchers Aaron Lyon and Kelly Koener in 2016. These principles aim to ensure interventions are grounded in the needs of the population they serve and the setting where they are implemented while still adhering to the best available evidence on how to achieve intended treatment outcomes.
In alignment with these principles, Wilson’s team employed a rapid iteration model when developing FNP. Rather than creating the intervention in full and then trialing it, this deployment-focused design entailed numerous cycles of soliciting feedback from target users — individuals with SMI and community mental health practitioners — and revising the intervention to incorporate their suggestions.
Alterations the researchers made in response to user feedback included changing its delivery frequency from twice a week to once a week to make it more feasible; adapting the language of the intervention to reflect that of the community mental health system rather than the criminal legal system to avoid perpetuating stigma; and centering the intervention’s content around key areas of everyday life for people with SMI living in community-based settings where risk behaviors can appear and developing coping strategies suited to those settings.
“It was the most challenging project of my life,” Wilson said regarding the sheer amount of revision required for the developing intervention to adequately respond to user feedback — not just making surface-level changes, but also incorporating significant structural shifts. Yet seeing how much energy and effort participants put into the review process made the experience deeply rewarding.
“It is humbling how many people really invested with us on this,” she said.
“When we’re successful — and I’m not going to say ‘if’ — in developing models that engage people in meaningful ways in community mental health systems, then we start to inform prevention. This would increase the number of services actively working to deflect people with serious mental illness from criminal legal system involvement by directing them toward community-based treatment services that address previously unmet needs.”
— Amy Blank Wilson, UNC SSW Professor
Another benefit of this considerable front-end effort was that it addressed development issues during the design stage, paving the way for a smoother and speedier testing process during clinical trials.
The first of these trials is already underway. Wilson and her research team are conducting a small-scale pilot examining FNP’s capacity to reduce criminal risk factors among individuals with SMI.
The preliminary outcomes of this pilot are encouraging and, once it is complete, Wilson and her research team plan to expand to a larger-scale trial with a focus on implementation.
New paths for research, practice and people
Additional areas of inquiry for FNP research are plentiful, including examining whether the intervention could be delivered in other community-based settings, such as those aimed at addressing substance use issues, or using digital app-based technology.
While these avenues of investigation are too plentiful for Wilson to pursue them all herself, other investigators are already taking up the mantel. These include members of Wilson’s current research team, two of whom — Jonathan Phillips and Anna Parisi — were once Wilson’s students in the School’s doctoral program.
"It’s really meaningful to work alongside colleagues who are also my former students,” Wilson said. “One of the most fulfilling and exciting parts of my work is watching research that I started grow and evolve through the work of people I have mentored."
by Lydia Rose Rappoport-Hankins
More information about TSDA is available in the article “Interventions that target criminogenic needs for justice-involved persons with serious mental illnesses: A targeted service delivery approach” in the May 2018 issue of International Journal of Offender Therapy and Comparative Criminology.
More information about FNP is available in the article “Forging new paths in the development of community mental health interventions for people with mental illness at risk of criminal legal system contact” in the January 2025 issue of Health & Justice.
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