Barriers and Recommendations to Implementing a Behavioral Health Intervention in a County Jail: Staff Perspectives

Background and Purpose: Project Evolve (PE) is a specialized behavioral health treatment program implemented in the Suffolk County Jail (SCJ) to better serve the needs of pre-trial detainees with psychiatric and/or substance use disorders. The project was implemented through a collaboration between the Suffolk County Sheriff’s Department (SCSD) and Boston Medical Center Health System (BMCHS). SCSD identified two vacant units at their Suffolk County Jail (SCJ) facility, where BMCHS implemented a specialized model of care based on clinical expertise leveraged from across the health system and current practices within the field. This study aims to examine the implementation of PE from the perspective of corrections officers (COs). Understanding COs experiences and views on the program is essential to inform implementation and quality improvement efforts of similar interventions.

Methods: We interviewed 30 jail staff during the first year of implementation, which was in 2025, to examine staff perspectives on feasibility and acceptability of PE, as well as implementation barriers and facilitators. The interview guide was informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Consolidated Framework for Implementation Research (CFIR). We collected data until we achieved thematic saturation and completed a cross-case content analysis using Dedoose Version 10.0.59.

Results: We identified three key themes from the data analysis. First, jail staff conveyed mixed levels of support for PE, but a general anticipation of positive impacts on clients. Some COs expressed discomfort regarding the greater autonomy afforded to detainees in the therapeutic setting, voicing their anxiety about safety in a less controlled environment. On the other hand, however, jail staff believed that services like those provided in PE were critically needed to better serve detainees with behavioral health issues. Second, challenges in PE implementation were described across COs, including cultural differences between jail and treatment staff, safety concerns, communication gaps between partners, and a lack of consensus on which detainees were most appropriate for the program. Third, COs provided recommendations for improving PE include strengthening communication mechanisms, implementing cross-training for jail and treatment staff, stricter implementation of jail protocols, and incorporating a re-entry component into the program for long-term program effectiveness.

Conclusions and Implications: The study results highlight both the barriers and potential for positive outcomes from jail staff perspectives, while identifying opportunities to address implementation challenges and improve program effectiveness. They underscore the need for trauma-informed, interdisciplinary collaboration that centers clients’ needs when designing behavioral health interventions for marginalized populations. In addition, findings emphasize the importance of interdisciplinary trainings for service providers to reduce friction within the program and to support its effective implementation. These findings offer insights into ways to optimize innovative behavioral health programs such as PE for pre-trial detainees.