By Kinsey Kranjcec and Nathan Alam
Over the last few decades, behavioral health has become increasingly recognized as a pillar of overall health. That growing attention has brought advances in treatment, efforts to reduce stigma, and greater focus on access to care. Yet, some populations remain overlooked by traditional systems of care. For people involved in the legal system, behavioral health needs can be especially difficult to address as treatment intersects with incarceration, reentry, and other demands of the justice system.
Among people who are incarcerated, post-traumatic stress disorder occurs at rates two to five times higher than in the general population. Left untreated, PTSD can contribute to substance use after release and a greater likelihood of reoffending—which can then exacerbate a cycle of trauma, addiction, and incarceration. Making effective treatment available to this population requires more than knowing what works; it also requires understanding how that care can realistically be delivered within and beyond jails and prisons.
That challenge is at the heart of the HEALS (Health and the Legal System) Lab at UAMS. Led by Melissa J. Zielinski, Ph.D., the lab studies ways to improve behavioral health care for people involved in the legal system. Two of its current projects—STRIDES2, a national study, and HOPE, based in Arkansas—show what that work looks like in practice.
At the national level, STRIDES2 is a National Institute on Drug Abuse (NIDA)-funded study examining Cognitive Processing Therapy (CPT) for incarcerated individuals who struggle with substance use disorder. CPT is a trauma-focused psychotherapy that has consistently been shown to reduce PTSD symptoms and improve related conditions such as depression. The HEALS team is comparing therapist-led group CPT that Dr. Zielinski adapted for criminal justice settings with a standard self-guided CPT workbook, looking at how each approach may affect participants’ substance use, mental health, and experiences after release. They are also evaluating ways to support prison staff as they deliver and sustain CPT within prison and examining the costs of both CPT and the implementation support to help determine what it would take for wider adoption.
Over five years, the study is enrolling 640 participants across 10 correctional facilities in five states. Researchers are following these participants from before treatment through six months after their release, tracking changes in PTSD and depression symptoms, substance use, and their experiences with treatment and criminal justice outcomes. Counselors at participating facilities are receiving CPT training and consultation at no cost with the goal of establishing CPT services that each prison can sustain after the study has ended.
Closer to home, HOPE is a NIDA-funded study in Pulaski County focused on the intersection of opioid use disorder (OUD), stimulant use disorder (StUD), and PTSD. For people with OUD and/or StUD, untreated PTSD is common and can make it harder to engage in substance use treatment and sustain recovery. HOPE is developing new approaches to screening for and treating these conditions in jails and in the community across two key phases. The first phase, which concluded in Fall of 2025, included building a collaborative team consisting of detention center staff, community treatment providers, nonprofit organizations, university medical center partners, and individuals with lived experience of incarceration, PTSD, and OUD. Together, they designed every aspect of a care pathway from how people are screened for OUD, StUD, and PTSD when they enter jail to how they are connected with treatment and ongoing care in the facility and after release. The team also selected evidence-based PTSD therapies that can be delivered both inside correctional facilities and after individuals return to the community in preparation for the second phase.
Phase two, which launched enrollment this March, is a large clinical trial involving 338 people with OUD and/or StUD and PTSD. Participants are randomly assigned to either receive PTSD treatment immediately, while still in jail, or to receive PTSD treatment upon community release. The HEALS team is following participants for 1 year after they enroll in the study to test whether beginning PTSD treatment during incarceration helps people start medication for OUD and continue their recovery after release compared to standard community referrals.
The work being done in the HEALS Lab extends far beyond just these two projects. However, both STRIDES2 and HOPE represent the important research the lab is dedicated to, and their mission to ensure that incarcerated people and people being released from prison are not met with gaps in care and not failed by the systems that have historically left them behind. Indeed, outside of their research studies, the team currently also offers group therapy services in one community correction center and has recently partnered with the state Administrative Office of the Courts to launch a new virtual mental health clinic that will eventually serve participants in Arkansas’ specialty courts statewide. As mental health and substance use remain pressing public health concerns, the lab’s work is helping identify what works, informing policies and programs, and expanding access to effective care for individuals and communities in Arkansas and beyond.