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Managed care and fee-for-service Medicaid programs did not differ on most measures; however, a lack of sufficient power was evident for many measures. Full endorsement of managed care for vulnerable populations will require further research that assumes low penetration rates and intersite variability.

This study examined the effectiveness of the Fitness Game, an intervention created for the restoration of competency to stand trial. Of 28 participants who completed either the experimental or control intervention at Hawai'i State Hospital (HSH), it was found that both groups had significant pretest to posttest improvements on Understanding and Appreciation subsets of the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA). However, there was no statistically significant difference between the groups on competency measures, indicating that the Fitness Game was not significantly more effective at restoring competency than non-legal programming. In other words, individuals committed to a psychiatric hospital for care and treatment were as likely to improve as those receiving additional specialized competency restoration treatment.