KEVIN K KNIGHT
@ibr.tcu.edu
Professor & Director, TCU Psychology Dept and TCU School of Medicine; Institute of Behavioral Research
Texas Christian University
Since joining the IBR faculty in 1991, Kevin Knight’s career has focused on researching substance-using criminal justice populations. He has served as the Principal Investigator (PI) on several research projects funded by NIDA (the National Institute of Drug Abuse), the National Institute of Justice (NIJ), and the National Institute of Corrections. He has also served as the TCU PI on a major NIDA Cooperative Agreement called Criminal Justice Drug Abuse Treatment Studies (CJ-DATS); a multisite project spanning over 12 years and focused on testing strategies to improve the implementation of evidence-based practices within a criminal justice setting. He currently serves as one of the Multiple PIs on one of two HEAL projects – the Justice Community Opioid Innovation Network or JCOIN project.
EDUCATION
1988-91: Texas Christian University, Fort Worth: Ph.D. (Experimental Psychology)
1985-88: Southern Methodist University, Dallas, TX: M.A. (Experimental Psychology)
1981-85: Southern Methodist University, Dallas, TX: B.A. (Psychology and Religion)
RESEARCH, TEACHING, or OTHER INTERESTS
Health Policy, Experimental and Cognitive Psychology, Infectious Diseases, Social Sciences
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Thomas B. Sease, Amanda L. Wiese, and Kevin Knight
SAGE Publications
This study used latent profile analysis to classify legally-involved persons in substance use treatment into mutually exclusive groups based on their clinical presentation of substance use and post-traumatic stress. Predictors of group membership were tested, and group classification was evaluated as a predictor of engagement in substance use treatment. There was a significant amount of variability in substance use and post-traumatic stress symptomatology at the start of treatment. Clients’ symptoms were classified into four groups: (1) high substance use, low trauma, (2) low substance use high trauma, (3) high substance use, high trauma, and (4) low substance use, low trauma. Psychological distress was the primary predictor of group classification and profile membership was differentially related to treatment engagement. Together, these results can be used to inform screening tools, assessment protocols, and adaptive treatment models to better serve people in the legal system experiencing comorbid substance use and post-traumatic stress.
Ank E. Nijhawan, Zoe Pulitzer, Brynn Torres, Natalie Noreen, Alysse Schultheis, Cynthia Frank, Richard Colon, Ralph Brooks, Randi Proffitt, Jennifer Pankow,et al.
Centers for Disease Control and Prevention (CDC)
Preexposure prophylaxis (PrEP) is underused in persons who use drugs and justice-involved persons. In an ongoing randomized controlled trial in 4 US locations comparing patient navigation versus mobile health unit on time to initiation of HIV medication or PrEP for justice-involved persons who use stimulants or opioids and who are at risk for or living with HIV, we assessed HIV risk factors, perceived HIV risk, and interest in PrEP. Participants without HIV (n = 195) were 77% men, 65% White, 23% Black, and 26% Hispanic; 73% reported a recent history of condomless sex, mainly with partners of unknown HIV status. Of 34% (67/195) reporting injection drug use, 43% reported sharing equipment. Despite risk factors, many persons reported their risk for acquiring HIV as low (47%) or no (43%) risk, although 51/93 (55%) with PrEP indications reported interest in PrEP. Justice-involved persons who use drugs underestimated their HIV risk and might benefit from increased PrEP education efforts.
Amanda Fallin-Bennett, Martha Tillson, J. Matthew Webster, Carrie B. Oser, Jennifer Edwards Becan, Kevin Knight, Jeremy Byard, and Michele Staton
Informa UK Limited
Thomas B. Sease and Kevin Knight
SAGE Publications
Criminal thinking patterns—attitudes, beliefs, or values supportive of criminal behavior—represent modifiable clinical targets that can be influenced during treatment as a way of decreasing clients’ risk for recidivism. This study developed a revised measure of criminal thinking based on the Texas Christian University Criminal Thinking Scales (TCU CTS). Using a sample of 797 people, results showed the revised instrument (TCU CTS 3.0) measured criminal thinking in five key areas: (1) Power Orientation, (2) Justification, (3) Insensitivity to Impact of Crime, (4) Grandiosity, and (5) Response Disinhibition. Confirmatory factor analysis showed the 5-factor solution reasonably fit the data and measurement invariance was achieved for assigned sex at birth and race. Implications and future directions are discussed.
J. D. Cance, E. T. Adams, E. J. D’Amico, A. Palimaru, C. S. F. Fernandes, L. E. Fiellin, E. E. Bonar, M. A. Walton, K. A. Komro, D. Knight,et al.
Springer Science and Business Media LLC
Amanda L. Wiese, Thomas B. Sease, Elizabeth D. Joseph, Jennifer E. Becan, Kevin Knight, and Danica K. Knight
Elsevier BV
George W. Joe, Wayne E. K. Lehman, Yang Yang, and Kevin Knight
SAGE Publications
Sample attrition is a confounding issue in the analysis of data collected in follow-up studies. The present study uses a regression procedure that includes a propensity score as a predictor in estimating imputed data. The utility of the procedure was addressed by comparing results from this augmented data with those from the original data. Data were from a randomized controlled study testing the utility of a tablet-based intervention designed to improve decision-making with respect to health risk behaviors. Outcomes included self-reported testing for HIV, STD, and hepatitis. Two samples were used (163 in community facilities and 348 in residential facilities). Seventy-eight in the community sample and 238 in the residential sample completed follow-up surveys. Propensity scores based on a stepwise logistic regression were used to make the calibration sample and the missing data sample as close as possible. Multilevel analysis was performed for each outcome and multiple imputation compared estimated mean differences for the augmented and original analyses. The model imputing missing data was effective for the three outcomes and increased power. Least square mean differences between augmented and original data appeared to be essentially the same for most of the outcomes. This protocol has been registered with https://www.clinicaltrials.gov/(NCT02777086).
George Joe, Thomas B. Sease, Wayne Lehman, Jennifer Pankow, and Kevin Knight
SAGE Publications
Justice-involved people with substance use disorders are an at-risk population for health risk behaviors, particularly those related to Human Immunodeficiency Virus (HIV) and other sexually transmitted infections. Risk-reduction programs provide correctional agencies with a practical solution in to reducing HIV-related health risks in justice-involved populations. This study compared two interventions (in-prison, group-based WaySafe with self-adminstered, tablet-based StaySafe for people on probation) to determine whether one intervention was more effective than the other in terms of common outcomes. Multi-level analyses compared effect sizes from outcome studies testing WaySafe and StaySafe. Results showed the interventions had similar effects with regard to measures of HIV Knowledge, HIV Services and Testing, and Risk Reduction Skills. Collectively, this study suggests the StaySafe intervention can be used in situations where the more intensive WaySafe intervention is not feasible and affords correctional agencies the flexibility to implement the curriculum that best meets their organization’s goals and needs.
George W. Joe, Wayne E. K. Lehman, Jennifer Pankow, Amanda Wiese, and Kevin Knight
Informa UK Limited
Abstract Background: People with substance use disorders often differ in their decision-making styles. The present study addressed the impact of two decision-making styles (rational and dependent) on outcomes from a StaySafe tablet computer app intervention designed to improve decision-making around health risk behaviors and previously found to be effective for justice-involved people receiving treatment for a substance use disorder and under community supervision. Objectives: Participants were justice-involved residents in residential treatment. After completing a baseline survey, participants were randomly assigned to either complete the StaySafe app or to a standard procedure condition; and then asked to complete a post-intervention survey three months after baseline (this protocol has been registered with clinicaltrials.gov NCT02777086): 348 participants completed a baseline survey and 238 completed the post-test survey. Outcomes included measures of confidence and motivation around HIV knowledge and risks and getting tested. Multilevel analyses addressed the hypothesis that outcomes were related to decision-making style. Multiple imputation (MI) was used to address the effects of missing data. Results: StaySafe was more effective for those in the lower half of the decision-making dependent scale for HIV risks (HIV-Knowledge, Hepatitis testing, HIV Services testing, and Sex Risk, as well as motivation for treatment. The decision-making rational scale was less consistently related to HIV risk. Conclusions: The present study showed individuals with substance use disorders who differed in their decision-making styles reacted differently to the StaySafe intervention. Two scales, rational decision making, and dependent decision making are relevant to consider with respect to interventions targeting improving decision making among drug users.
Thomas B. Sease, Cathy R. Cox, and Kevin Knight
Frontiers Media SA
Much work in psychology has focused on feelings of social isolation and/or loneliness. Only recently have psychologists begun to explore the concept of existential isolation (EI). EI is the subjective sense that persons are alone in their experience and that others are unable to understand their perspective. EI thus occurs when people feel that they have a unique worldview unshared by others. Measured as either a state or trait, empirical studies have shown EI undermines life meaning and decreases well-being; people scoring high on EI report lower levels of need satisfaction, purpose in life, and meaningfulness and increased death-related concerns. There is also a positive correlation between EI and anxiety, depression, and suicidal ideation. The purpose of this perspective paper is to review literature on EI and discuss its relevance to people who have been involved with the justice system. Given their higher rates of substance use, mental health difficulties, and trauma, this traditionally underserved population is particularly susceptible to compromised well-being. We theorize that EI may impede the impact of therapeutic interventions in justice settings as more isolated individuals may feel disjointed from their counselors and peers, thereby decreasing levels of treatment engagement, participation, satisfaction, and perceived social support. Professionals may be able to mitigate issues related to EI by an enhanced focus on establishing authenticity within the therapist-client relationship (e.g., empathy, perspective taking, compassion), connecting with clients via I-sharing [i.e., matching on a shared experience(s)], and/or encouraging active participation in client’s behavioral healthcare needs (e.g., self-reflection).
Sandra A. Springer, Ank E. Nijhawan, Kevin Knight, Irene Kuo, Angela Di Paola, Esther Schlossberg, Cynthia A. Frank, Mark Sanchez, Jennifer Pankow, Randi P. Proffitt,et al.
Springer Science and Business Media LLC
Abstract Background Persons involved in the justice system are at high risk for HIV and drug overdose upon release to the community. This manuscript describes a randomized controlled trial of two evidence-based linkage interventions for provision of HIV prevention and treatment and substance use disorder (SUD) services in four high risk communities to assess which is more effective at addressing these needs upon reentry to the community from the justice system. Methods This is a 5-year hybrid type 1 effectiveness-implementation randomized controlled trial that compares two models (Patient Navigation [PN] or Mobile Health Unit [MHU] service delivery) of linking justice-involved individuals to the continuum of community-based HIV and SUD prevention and treatment service cascades of care. A total of 864 justice-involved individuals in four US communities with pre-arrest histories of opioid and/or stimulant use who are living with or at-risk of HIV will be randomized to receive either: (a) PN, wherein patient navigators will link study participants to community-based service providers; or (b) services delivered via an MHU, wherein study participants will be provided integrated HIV prevention/ treatment services and SUD services. The six-month post-release intervention will focus on access to pre-exposure prophylaxis (PrEP) for those without HIV and antiretroviral treatment (ART) for people living with HIV (PLH). Secondary outcomes will examine the continuum of PrEP and HIV care, including: HIV viral load, PrEP/ ART adherence; HIV risk behaviors; HCV testing and linkage to treatment; and sexually transmitted infection incidence and treatment. Additionally, opioid and other substance use disorder diagnoses, prescription, receipt, and retention on medication for opioid use disorder; opioid and stimulant use; and overdose will also be assessed. Primary implementation outcomes include feasibility, acceptability, sustainability, and costs required to implement and sustain the approaches as well as to scale-up in additional communities. Discussion Results from this project will help inform future methods of delivery of prevention, testing, and treatment of HIV, HCV, substance use disorders (particularly for opioids and stimulants), and sexually transmitted infections for justice-involved individuals in the community. Trial registration: Clincialtrials.gov NCT05286879 March 18, 2022.
Amanda L. Wiese, Thomas B. Sease, Danica K. Knight, and Kevin Knight
Informa UK Limited
Abstract It is important to identify substance use disorders among youth who enter the juvenile justice system using a validated screener, such as the Texas Christian University Drug Screen 5 (TCU DS 5), so that necessary services can be provided to youth in need of treatment. While the TCU DS 5 is a valid, evidence-based screener, the use of an Item Response Theory model may better differentiate between mild, moderate, and severe forms of substance use disorders. The current study analyzed the feasibility and incremental value gained in using an Item Response Theory model to compute drug use severity scores as compared to its current scoring methodology. Results showed that while Item Response Theory may not be worthwhile as the standard method of scoring, item level analyses revealed there are benefits to using Item Response Theory to determine which items on a screener are most suggestive of severe substance use problems.
Thomas B. Sease, George Joe, Jennifer Pankow, Wayne E. K. Lehman, and Kevin Knight
Informa UK Limited
Abstract In the United States, approximately 9 million people cycle in and out of jail and more than 600,000 people are released from prison each year. Unfortunately, the reentry process includes several barriers people must overcome (e.g., criminal thinking) to achieve adequate psychosocial functioning. As such, valid and reliable assessments that allow correctional staff to monitor clients’ progress in treatment and test program effectiveness are paramount to reducing this major public safety concern. The TCU Criminal Thinking Scales (CTS) are a widely used assessment of criminal thinking in correctional settings. This study reevaluated the psychometric properties of the TCU CTS using Item Response Theory. Results showed the TCU CTS had good internal reliability and each scale loaded onto one factor. Item level analysis revealed most items adequately fit the model, generally measuring moderate levels of criminal thinking. Furthermore, several TCU CTS scales were negatively correlated with motivation for treatment and psychosocial functioning.
Danica Kalling Knight, Yang Yang, Elizabeth D. Joseph, Elaine Tinius, Shatoya Young, Lillyan T. Shelley, David R. Cross, and Kevin Knight
Springer Science and Business Media LLC
Abstract Background Juvenile justice (JJ) youth are at high risk of opioid and other substance use (SU), dysfunctional family/social relationships, and complex trauma. The purpose of the Leveraging Safe Adults (LeSA) Project is to examine the effectiveness of Trust-Based Relational Intervention® (TBRI®; leveraging family systems by providing emotional and instrumental guidance, support, and role modeling) in preventing opioid and other SU among youth after release from secure residential facilities. Methods An effectiveness-implementation Hybrid Type 1 design is used to test the effectiveness of TBRI for preventing non-medical use of opioids among JJ-youth (delayed-start at the site level; a randomized controlled trial at participant level) and to gain insight into facility-level barriers to TBRI implementation as part of JJ re-entry protocols. Recruitment includes two samples (effectiveness: 360 youth/caregiver dyads; implementation: 203 JJ staff) from nine sites in two states over 3 years. Participant eligibility includes 15 to 18-year-olds disposed to community supervision and receiving care in a secure JJ facility, without active suicide risk, and with one caregiver willing to participate. Effectiveness data come from (1) youth and caregiver self-report on background, SU, psychosocial functioning, and youth-caregiver relationships (Months 0, 3, 6, 12, and 18), youth monthly post-release check-ins, and caregiver report on youth psychological/behavioral symptoms, and (2) JJ facility records (e.g., recidivism, treatment utilization). Fidelity assessment includes post-session checklists and measures of TBRI strategy use. Collected four times over four years, implementation data include (1) JJ staff self-report on facility and staff characteristics, use of trauma-informed care and TBRI strategies, and (2) focus groups (line staff, leadership separately) on use of trauma-informed strategies, uptake of new interventions, and penetration, sustainment, and expansion of TBRI practices. Discussion The LeSA study is testing TBRI as a means to empower caregivers to help prevent opioid use and other SU among JJ-youth. TBRI’s multiple components offer an opportunity for caregivers to supplement and extend gains during residential care. If effective and implemented successfully, the LeSA protocol will help expand the application of TBRI with a wider audience and provide guidance for implementing multi-component interventions in complex systems spanning multiple contexts. Trial registration ClinicalTrials.govNCT04678960; registered November 11, 2020; https://clinicaltrials.gov/ct2/show/NCT04678960.
Wayne E.K. Lehman, Jen Pankow, Roxanne Muiruri, George W. Joe, and Kevin Knight
Elsevier BV
Noor Taweh, Esther Schlossberg, Cynthia Frank, Ank Nijhawan, Irene Kuo, Kevin Knight, and Sandra A. Springer
Elsevier BV
Danica Knight, Jennifer Becan, David Olson, Noah Painter Davis, Justin Jones, Amanda Wiese, Pam Carey, Dona Howell, and Kevin Knight
Elsevier BV
Fivos E. Papamalis, Ioannis Dritsas, and Kevin Knight
Informa UK Limited
Abstract Background Treatment initiation is a major factor contributing to positive outcomes, but the supporting literature remains limited. It is difficult to draw conclusions regarding predictors of dropout, and there is a need to target clients’ major early attrition vulnerabilities. Despite empirically validated models for assessing personality, little is known about its role in the treatment process. Studies that have been conducted in this area have focused mainly on stable personality traits and provide conflicting evidence. Aims: The aim of this study is to examine to what extent service users’ personality functioning are potential determinants of early drop out. Methodology: A cross-sectional multi-site design examined the therapy process in a naturalistic setting in 5 outpatient preparation treatment centers with 210 service users. The current study adopts a contemporary dimensional-based framework, similar to the Alternative Model of Personality Disorder of the DSM-V and examines the role of characteristic adaptations (SIPP-118) on early drop out (CEST-Intake). Findings: From the broad spectrum of personality traits, only Depression remained significant predictor of drop out. Higher dysfunctional levels in Social Concordance [OR] = 1.85, Wald =19.87, p =.002, 95% CI [1.1, 1.9] as well as the facets Aggression Regulation, Respect and Purposefulness were also predictors of early drop out, while Treatment Readiness and Desire for Help accounted for a significant amount of variance. Conclusions: These findings extend our knowledge of the predictive role of characteristic adaptations in treatment and suggest it may be important to assess these individual differences early on and to design personalized-informed interventions.
William E. Cunningham, Robin M. Nance, Carol E. Golin, Patrick Flynn, Kevin Knight, Curt G. Beckwith, Irene Kuo, Anne Spaulding, Faye S. Taxman, Fredrick Altice,et al.
Springer Science and Business Media LLC
Abstract Background Self-reported antiretroviral therapy (ART) adherence measures that are associated with plasma viral load (VL) are valuable to clinicians and researchers, but are rarely examined among groups vulnerable to dropping out of care. One-seventh of all those living with HIV pass through incarceration annually and criminal-justice (CJ) involved people living with HIV (PLH) are vulnerable to falling out of care. We examined the association of self-reported ART adherence with VL in a criminal-justice sample compared to a routine-care sample. Methods Samples: We examined data from a multisite collaboration of studies addressing the continuum of HIV care among CjJ involved persons in the Seek, Test, Treat, and Retain cohort. Data pooled from seven CJ- studies (n = 414) were examined and compared with the routine-care sample from the Centers for AIDS Research Network of Integrated Clinical Systems’ seven sites (n = 11,698). Measures: In both samples, data on self-reported percent ART doses taken were collected via the visual analogue scale adherence measure. Viral load data were obtained by blood-draw. Analysis: We examined the associations of adherence with VL in both cohorts using mixed effects linear regression of log-VL, and mixed effects logistic regression of binary VL (≥ 200 copies/mL) outcomes. Interactions by CD4 count and self-reported health status were also tested. Results Among the CJ sample, the coefficient for log-VL was − 0.31 (95% CI = − 0.43, − 0.18; P < 0.01) and that in the routine-care sample was − 0.42 (95% CI = − 0.45, − 0.38; P < 0.01). For the logistic regression of binary detectable VL on 10% increments of adherence we found the coefficient was − 0.26 (95% CI = − 0.37, − 0.14; P < 0.01) and in the routine-care sample it was − 0.38 (95% CI = − 0.41, − 0.35; P < 0.01). There was no significant interaction by CD4 count level in the CJ sample, but there was in the routine-care sample. Conversely, there was a significant interaction by self-reported health status level in the criminal-justice sample, but not in the routine-care sample. Conclusions The visual analogue scale is valid and useful to measure ART adherence, supporting treatment for CJ- involved PLH vulnerable to falling out of care. Research should examine adherence and VL in additional populations.
Bethany L. DiPrete, Brian W. Pence, Carol E. Golin, Kevin Knight, Patrick M. Flynn, Jessica Carda-Auten, Jennifer S. Groves, Kimberly A. Powers, Becky L. White, Sonia Napravnik,et al.
Springer Science and Business Media LLC