Abstract: Solitary confinement is a widespread practice in US correctional facilities. Long-standing concerns about the physical and mental health effects of solitary confinement have led to litigation, legislation, and community activism resulting in many prison systems introducing policies or implementing legal mandates to reduce or eliminate its use. Yet little is known about the nature and effectiveness of policies that states have adopted to reduce their use of solitary confinement and exactly how various reforms have actually impacted the lives of people living and working in the prisons where these reforms have taken place. Methods We conducted an embedded case study, analyzing changes in policies and procedures, administrative data, and focus groups and interviews with incarcerated persons and staff, to describe the circumstances that led to changes in solitary confinement policies and practices in the North Dakota Department of Corrections and Rehabilitation (ND DOCR) and the perceived impact of these changes on incarcerated persons and prison staff. . Results North Dakota’s correctional officials and staff members attributed the impetus to change their solitary confinement policies to their participation in a program that directly exposed them to the Norwegian Correctional Service’s philosophy, policies, and practices in 2015. The ensuing policy changes made by North Dakota officials were swift and resulted in a 74.28% reduction in the use of solitary confinement between 2016 and 2020. Additionally, placements in any form of restrictive housing decreased markedly for incarcerated persons with serious mental illness. In the two prisons that had solitary confinement units, rule infractions involving violence decreased at one prison overall and it decreased within the units at both prisons that were previously used for solitary confinement. Although fights and assaults between incarcerated people increased in one of the prison’s general population units, during the initial months of reforms, these events continued to decline compared to years before reform. Moreover, incarcerated people and staff attributed the rise to a concomitant worsening of conditions in the general population due to overcrowding, idleness, and double bunking. Both incarcerated persons and staff members reported improvements in their health and well-being, enhanced interactions with one another, and less exposure to violence following the reforms. Conclusions Immersing correctional leaders in the Norwegian Correctional Service’ public health and human rights principles motivated and guided the ND DOCR to pursue policy changes to decrease the use of solitary confinement in their prisons. Ensuing reductions in solitary confinement were experienced as beneficial to the health and wellness of incarcerated persons and staff alike. This case-study describes these policy changes and the perspectives of staff and incarcerated persons about the reforms that were undertaken. Findings have implications for stakeholders seeking to reduce their use of solitary confinement and limit its harmful consequences and underscore the need for research to describe and assess the impact of solitary confinement reforms. PubDate: 2021-10-18
Abstract: Background With over 11 million people incarcerated globally, prevention and control of COVID-19 in custodial settings is a critical component of the public health response. Given the risk of rapid transmission in these settings, it is important to know what guidance existed for responding to COVID-19 in the early stages of the pandemic. We sought to identify, collate, and summarise guidance for the prevention and control of COVID-19 in custodial settings in the first six months of 2020. We conducted a systematic search of peer-reviewed and grey literature, and manually searched relevant websites to identify publications up to 30 June 2020 outlining recommendations to prevent and/or control COVID-19 in custodial settings. We inductively developed a coding framework and assessed recommendations using conventional content analysis. Results We identified 201 eligible publications containing 374 unique recommendations across 19 domains including: preparedness; physical environments; case identification, screening, and management; communication; external access and visitation; psychological and emotional support; recreation, legal, and health service adaptation; decarceration; release and community reintegration; workforce logistics; surveillance and information sharing; independent monitoring; compensatory measures; lifting control measures; evaluation; and key populations/settings. We identified few conflicting recommendations. Conclusions The breadth of recommendations identified in this review reflects the complexity of COVID-19 response in custodial settings. Despite the availability of comprehensive guidance early in the pandemic, important gaps remain in the implementation of recommended prevention and control measures globally, and in the availability of evidence assessing their effectiveness on reducing COVID-19 disease, impact on people in custody and staff, and implementation. PubDate: 2021-10-15
Abstract: Background Although it is clear that incarcerated women need access to effective therapies for trauma sequelae, some have argued that one of the most effective treatments – exposure therapy – should not be provided in carceral settings due to the presumed lack of safety and stability making such an intervention inappropriate. Group therapy, the typical mode of intervention in prisons, has also been presumed to be unacceptable for exposure-based processing due to assumptions that hearing others’ trauma narratives would be traumatizing and unhelpful to listeners. However, there is a lack of data to support either of the aforementioned assumptions. This study examined the acceptability of an exposure-based group therapy for women survivors of sexual violence who were currently incarcerated (N = 61) by asking women themselves about their experiences completing an exposure-based group therapy protocol (SHARE; Survivors Healing from Abuse: Recovery through Exposure) while incarcerated. We assessed women’s reasons for enrolling in the group, satisfaction with various therapy components (e.g., exposure, skill-building) and the treatment overall, and experiences of both sharing and listening to trauma narratives using a feedback survey that included a mix of multiple-choice and open-ended questions. Treatment dropout was examined as an additional index of acceptability. Results Treatment completion was very high (88.8%). Nearly all women who completed the group reported that they would recommend it to other incarcerated women (96.7%, with the remaining 3.3% reporting “it depends”). Qualitative results revealed overwhelmingly positive feedback about the effect of the group and indicated that sharing and listening to trauma narratives in a group setting serve discrete but dually important functions. Specifically, women almost universally experienced listening to others’ trauma narratives (i.e., exposures) in the SHARE group context as helpful—making them feel less alone and normalizing their experiences. Sharing one’s own story primarily provided an emotional release and/or transformation (i.e., an intrapersonal rather than interpersonal function). Conclusions Our findings challenge common concerns about the appropriateness of 1) prison as a context for trauma-focused treatments, including exposure and 2) sharing trauma narratives in a group setting. Unless empirical evidence demonstrating harm is uncovered, best practices for PTSD and other trauma-related sequelae—those recommended in reputable treatment guidelines and interventions like SHARE that incorporate components shown to be effective (e.g., cognitive challenging, exposure)—should be offered to incarcerated women as part of standard of care. PubDate: 2021-09-30
Abstract: Background Healthcare fraud entails great financial and human losses; however, there is no consensus regarding its definition, nor is there an inventory of its manifestations and factors. The objective is to identify the definition, manifestations and factors that influence health insurance fraud (HIF). Methods A scoping review on health insurance fraud published between 2006 and 2020 was conducted in ACM, EconPapers, PubMed, ScienceDirect, Scopus, Springer and WoS. Results Sixty-seven studies were included, from which we identified 6 definitions, 22 manifestations (13 by the medical provider, 7 by the beneficiary and, 2 by the insurance company) and 47 factors (6 macroenvironmental, 15 mesoenvironmental, 20 microenvironmental, and 6 combined) associated with health insurance fraud. We recognized the elements of fraud and its dependence on the legal framework and health coverage. From this analysis, we propose the following definition: “Health insurance fraud is an act of deception or intentional misrepresentation to obtain illegal benefits concerning the coverage provided by a health insurance company”. Among the most relevant manifestations perpetuated by the provider are phantom billing, falsification of documents, and overutilization of services; the subscribers are identity fraud, misrepresentation of coverage and alteration of documents; and those perpetrated by the insurance company are false declarations of benefits and falsification of reimbursements. Of the 47 factors, 25 showed an experimental influence, including three in the macroenvironment: culture, regulations, and geography; five in the mesoenvironment: characteristics of provider, management policy, reputation, professional role and auditing; 12 in the microenvironment: sex, race, condition of insurance, language, treatments, chronic disease, future risk of disease, medications, morale, inequity, coinsurance, and the decisions of the claims-adjusters; and five combined factors: the relationships between beneficiary-provider, provider-insurance company, beneficiary-insurance company, managers and guānxi. Conclusions The multifactorial nature of HIF and the characteristics of its manifestations depend on its definition; Identifying the influence of the factors will support subsequent attempts to combat HIF. PubDate: 2021-09-30
Abstract: Background Over the past decade there have been numerous and impassioned calls to reform the practice of solitary confinement in U.S. prisons. This article examines the development, implementation, and processes of a restrictive housing reentry program in the Oregon Department of Corrections. It draws on data from official documents, site observations, and interviews with 12 prison officials and 38 prisoners. The Step Up Program (SUP) seeks to improve the living conditions in restrictive housing over business-as-usual, alleviate physiological and psychological harms of solitary confinement, and use rehabilitative programming to increase success upon returning to the general prison population or community. Results The impetus to change the culture and structure of restrictive housing was primarily the result of internal administrative reform. Prisoners assigned at random to housing assignments offered accounts of their daily activities suggesting that the SUP provides more time out-of-cell and greater access to other services and activities. Program participants preferred the living conditions in the SUP because they had more opportunities for social interaction and incentives for compliant behavior. However, views on the value of programming among respondents were mixed. Conclusions The launch of the SUP occurred in early 2020, which was soon followed by the COVID-19 pandemic. As a result, the program was never fully implemented as intended. As Oregon returns to more normal operations, it is possible that the SUP will be able to include even more out-of-cell time, greater socialization opportunities, and increased access to programming and other beneficial activities. As we await the opportunity to conduct prospective psychological and behavioral analyses, this study provides tentative support for the use of step down reentry programs in restrictive housing units. Trial registration Open Science Framework, Preparing adults in custody for successful reentry: An experimental study of a restrictive housing exit program in Oregon. Registered 4 October 2019, https://osf.io/t6qpx/ PubDate: 2021-08-26
Abstract: Background Justice-involved populations report a higher than average number of pre-incarceration stressful life events. However, few studies have described stressful life events which occur during incarceration, explored gender differences in these events, or evaluated the effect of these events on well-being. Method This study draws from a sample of male and female adults incarcerated in 6 prison facilities across two states (n = 160) to identify the number and type of stressful life events they experienced during incarceration, gender differences in stressful events, and the relationship between stressful life events and markers of well-being (i.e., depression, hopelessness, loneliness, suicidality). We also examined whether perceived social support would buffer the relationship between stressful events and well-being outcomes. Results Participants on average reported experiencing 4 stressful life events during their current incarceration, the most common being relocation to another cell and being made fun of/insulted by someone in the prison. There were few gender differences in types of events experienced. Regression analyses showed that stressful life events were associated with more loneliness, as well as suicidality, but only when participants had low perceived social support. Conclusions Stressful life events, and drawing on social support networks to cope with stress, should be addressed in the context of correctional treatments to reduce suicide risk during incarceration. PubDate: 2021-08-24
Abstract: Background Mass incarceration has had an undeniable toll on childhood poverty and inequality, however, little is known about the consequences on pediatric health. The purpose of this study was to identify and describe the health of pediatric patients with probable personal or family history involvement with the correctional system. Methods A descriptive study was conducted using electronic health record data of 2.3 million youth (ages 0–21 years) who received care in a large Midwestern hospital-based institution from February 2006–2020. We employed a correctional-related keyword search (e.g. jail, prison, probation, parole) to locate youth with probable personal or family history involvement. Health characteristics were measured as clinician diagnostic codes. Results Two percent of the total pediatric population had a correctional keyword in the medical chart (N = 51,855). This 2% made up 66% of all patients with cannabis-related diagnoses, 52% of all patients with trauma-related diagnoses, 48% of all stress-related diagnoses, 38% of all patients with psychotic disorder diagnoses, and 33% of all suicidal-related disorders within this institution’s electronic health record database – among other highly concerning findings. Conclusions We captured an alarming health profile that warrants further investigation and validation methods to better address the gaps in our clinical understanding of youth with personal or family history involvement with the correctional system. We can do better in identifying, and supporting families affected by the correctional system. PubDate: 2021-08-01
Abstract: Background In light of mounting evidence of the physical and psychological harms associated with solitary confinement, many correctional systems, state legislators, courts, and even international human rights bodies are increasingly recommending and implementing reforms to mitigate the harms of solitary confinement, if not abolish the practice entirely. In this piece, we examine three specific infrastructural changes to solitary confinement conditions and practices implemented in Washington state prisons with such harm minimization goals in mind: (1) building so-called “nature imagery rooms” to play videos of outdoor spaces, (2) eliminating punishments for self-harm, and (3) conducting daily cell-front wellness checks. Results Drawing on 183 in-depth qualitative interviews with both staff working in and people imprisoned in solitary confinement units conducted in Washington state restrictive housing units in 2017, we find that these three reforms not only resulted in limited successes but also generated new conflicts. Institutional logics such as deprivation, risk-management, and responsibilization ultimately impeded even the most modest attempts to mitigate the inherently harsh practice of solitary confinement. The limits of these reforms are due in part to individual choices made by people imprisoned in solitary confinement and staff working in these units, as well as the larger cultural norms that shape life in restrictive housing units. Conclusions Incrementalist reforms aimed at softening the environment of solitary confinement may actually serve to increase the strain and stress experienced by people confined to and working within them. Even the most well-intentioned reforms, like those attempted by the Washington DOC, should be scrutinized in order to determine if they are producing the desired outcomes, or instead, reproducing a different, but nonetheless damaging set of harms to people imprisoned in solitary confinement. Further, even well-intentioned reforms are often stymied by the underlying institutional logics of restrictive housing spaces. PubDate: 2021-07-31
Abstract: Objective Prisoners complete suicide and self-harm more frequently than members of the community. Sex offenders have been found to be at greater risk of engaging in these behaviours. This study examines the characteristics, prevalence, and predictors of self-harm and suicide attempts among: sex offenders that only victimise children (ChildSOs); adults (AdultSOs); or both (age-crossover polymorphous; PolySOs). Methods Data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey was linked to the State’s re-offending database to identify men with histories of sexual offending. The health surveys captured self-report data on self-harm and suicidality. Results Non-sexual violent offenders (15%) and AdultSOs (14%) had the highest rate of self-harm, significantly more than ChildSOs (11%), non-sexual non-violent offenders (10%), and PolySOs (0%). Several factors significantly predicted self-harm at the bivariate level for both ChildSOs and AdultSOs, with unique predictors for each group. At the multivariate level, manic-depression trended towards significance for ChildSOs and any mental health condition remained a significant predictor for AdultSOs who self-harmed relative to AdultSOs who had not (aOR = 11.989, 95%CI [1.14, 126.66]). Approximately 23% of AdultSOs, 22% of PolySOs, and 19% of ChildSOs reported a suicide attempt throughout their lifetime, whereas only 15% of non-sexual non-violent offenders reported an attempt. At the bivariate level, few factors were significant for ChildSOs while several factors were significant for AdultSOs. At the multivariate level, a diagnosis of depression and treatment with psychiatric medication trended towards being significant predictors of suicide attempts for ChildSOs. In contrast, treatment with psychiatric medication (aOR = 25.732, 95%CI [1.91, 347.19])] remained a significant predictor for AdultSOs who attempted suicide relative to AdultSOs who had not, as well as historical psychiatric hospitalisation (aOR = 6.818, 95%CI [1.04, 44.82]) and self-harm (aOR = 5.825, 95%CI [1.31, 25.99]). Conclusion Sex offenders are at significantly higher risk of attempting and completing suicide relative to non-sexual non-violent offenders and warrant special attention. The prevalence rates and predictors of self-harm and suicidality suggest differences between sex offender subgroups may exist. These hold implications for the criminal justice and public health systems for addressing needs and identifying those most at risk of self-harm and suicide. PubDate: 2021-07-27
Abstract: Introduction Limited research has focused on the trajectories of victimization to violence in women’s lives. Furthermore, literature assessing women’s use of violence has primarily focused on adult risk factors (e.g., substance use and criminal histories). Drawing from the pathway’s framework, we explored the impact of multiple forms of childhood victimization and subsequent harmful behaviors on adult-perpetrated violence among women convicted of violent or serious crimes. Methods This secondary data analysis included a sample of 1118 incarcerated women from two prisons. Based on prior literature outlining the lifelong negative impact of childhood victimization, we hypothesized that cumulatively, occurrence of abuses, arrest as a minor, number of lifetime arrests, and poly-substance use prior to incarceration, would increase the likelihood of perpetration of multiple forms of violence. GEE regression models were used to examine the relationship between the predictors and adult perpetration of intimidation and physical violence. Results Experiences with childhood victimization, early (under age 18) and ongoing criminal justice involvement, and substance use significantly increased the likelihood of adult perpetration of violence, regardless of the type of violence measured (intimidation or physical violence). Conclusion Given the documented high prevalence of childhood trauma and abuse among justice-involved women, findings from this study can be used to promote the implementation of trauma-specific treatment for at-risk juvenile girls, whose trajectories of violence might be mitigated. PubDate: 2021-07-27
Abstract: Background Prior studies have documented limited use of medications to treat opioid use disorders (OUD) for people incarcerated within state prisons in the United States. Using the framework of the criminal justice OUD service cascade, this study interviewed representatives of prison systems in states most heavily impacted by opioid overdose regarding the provision of medications for OUD (MOUD). Methods A stratified sampling strategy included states with high indicators of opioid-overdose deaths. Two sampling strata targeted states with: 1) OUD overdose rates significantly higher than the per capita national average; or 2) high absolute number of OUD overdose fatalities. Interviews were completed with representatives from 21 of the 23 (91%) targeted states in 2019, representing 583 prisons across these states. Interviews assessed service provision across the criminal justice OUD service cascade, including OUD screening, withdrawal management, MOUD availability and provision, overdose prevention, re-entry services, barriers, and needs for training and technical assistance. Results MOUD (buprenorphine, methadone, or naltrexone) was available in at least one prison in approximately 90% of the state prison systems and all three medications were available in at least one prison in 62% of systems. However, MOUD provision was limited to subsets of prisons within these systems: 15% provided buprenorphine, 9% provided methadone, 36% provided naltrexone, and only 7% provided all three. Buprenorphine and methadone were most frequently provided to pregnant women or individuals already receiving these at admission, whereas naltrexone was primarily used at release. Funding was the most frequently cited barrier for all medications. Conclusion Study findings yield a complex picture of how, when, and to whom MOUD is provided across prisons within prison systems in states most heavily impacted by opioid overdose in the United States and have implications for expanding availability. PubDate: 2021-07-24
Abstract: Background The disproportionately high rate of incarceration and COVID-19 cases during the summer of 2020 in the United States contributed to a set of circumstances that has produced considerable public health concerns as correctional facilities have emerged as significant COVID-19 hot spots. During the COVID-19 pandemic, having a family member incarcerated can be an especially stressful experience. This study assesses how concern about an incarcerated family member contracting COVID-19 impacts diverse coping strategies. Results Data are from a survey of individuals who have a family member incarcerated in Texas (N = 365). Ordinary least squares regression is used to examine the association between concern about an incarcerated family member contracting COVID-19 and coping strategies. Findings demonstrate that higher levels of concern for an incarcerated person’s wellbeing during the COVID-19 pandemic is associated with dysfunctional coping mechanisms, but not adaptive or functional coping strategies. Conclusions Results suggest appropriate systemic responses by correctional administrations and public health practices can help mitigate dysfunctional coping mechanisms by family members during infectious disease outbreaks in correctional facilities. PubDate: 2021-07-09
Abstract: Background Individuals who are incarcerated have greater healthcare needs than non-justice-involved individuals, yet incarcerated individuals often report substandard care. There are disproportionate numbers of black, indigenous, and people of color (BIPOC) in prison, who, even in general society face greater obstacles to accessing healthcare and have worse health outcomes due to structural racism. Regardless of race, people with criminal justice involvement often report stigma from the non-carceral healthcare system. Providing sufficient healthcare in carceral settings themselves is complicated by lack of privacy and the inherent dialectic of prisons that restrict freedom and providers focusing on healing and health. Based on these adverse experiences, people who are incarcerated may have decreased distrust in the healthcare system, deterring individuals from getting adequate medical care. Methods In this exploratory study, health care system distrust was evaluated among 200 people who were incarcerated using the Revised Health Care System Distrust scale, a community-validated, 9-item measure comprised of 2 subscales (values and competence distrust). Results Distrust was moderately and positively associated with participant age (rs = 0.150, p = 0.034), with the second-oldest quintile (33 to 42-year-olds) reporting the highest level of overall and competence distrust. Participants identifying as Non-Latinx White reported higher competence distrust compared to Latinx and Non-Latinx/Non-White respondents. Conclusions These preliminary findings suggest that select groups of prisoners may be less likely to trust the healthcare system, highlighting an impediment to receiving adequate care while incarcerated. Further study of this topic is warranted. PubDate: 2021-07-03
Abstract: Background While incarcerated people are known to experience trauma at higher rates than the general population, little is known about how the correctional health system contributes to trauma rates. Methods We conducted 20 semi-structured qualitative interviews with men who were recently released from a correctional system to understand their experiences with healthcare systems and medical staff during incarceration. Using reflexive thematic analysis within a critical realist framework, we coded and analyzed the data iteratively to refine and unify emerging themes. Results The unanticipated concept of healthcare-induced trauma emerged and was revealed in three overall themes: (1) healthcare leading to fear of serious illness or death, (2) healthcare leading to fear of people, including healthcare providers, correctional staff, and other incarcerated people, and (3) the correctional institutional, social, and physical environment leads to fear of place. Conclusions Healthcare in correctional settings has the potential to induce trauma, even when the medical conditions addressed are not life-threatening. Future research should examine the factors contributing to the development of healthcare-induced trauma in correctional settings and develop interventions to prevent and address this phenomenon. PubDate: 2021-06-21
Abstract: Background Fentanyl and related compounds have recently saturated the illicit drug supply in the United States, leading to unprecedented rates of fatal overdose. Individuals who are incarcerated are particularly vulnerable, as the burden of opioid use disorder is disproportionately higher in this population, and tolerance generally decreases during incarceration. Methods We conduct a systematic search for publications about fentanyl overdoses during incarceration in PubMed and PsycINFO, as well as lay press articles in Google, from January 1, 2013 through March 30th, 2021. Results Not a single fentanyl overdose was identified in the medical literature, but 90 overdose events, comprising of 76 fatal and 103 nonfatal fentanyl overdoses, were identified in the lay press. Among the 179 overdoses, 138 occurred in jails and 41 occurred in prisons, across the country. Conclusions Fentanyl-related overdoses are occurring in correctional facilities with unknown but likely increasing frequency. In addition to the need for improved detection and reporting, immediate efforts to 1) increase understanding of the risks of fentanyl and how to prevent and treat overdose among correctional staff and residents, 2) ensure widespread prompt availability of naloxone and 3) expand the availability of medications to treat opioid use disorder for people who are incarcerated will save lives. PubDate: 2021-05-19
Abstract: Background Millions of people pass through U.S. jails annually. Conducting research about these public institutions is critical to understanding on-the-ground policies and practices, especially health care services, affecting millions of people. However, there is no existing database of the number, location, or contact information of jails. We created the National Jails Compendium to address this gap. In this paper, we detail our comprehensive methodology for identifying jail locations and contact information. We then describe the first research project to use the Compendium, a survey assessing jails’ treatment practices for incarcerated pregnant people with opioid use disorder. Results This study sent surveys electronically or in paper form to all 2986 jails in the Compendium, with 1139 surveys returned. We outline the process for using the Compendium, highlighting challenges in reaching contacts through case examples, cataloging responses and non-responses, and defining what counts as a jail. Conclusion We aim to provide tools for future researchers to use the Compendium as well as a pathway for keeping it current. The Compendium provides transparency that aids in understanding jail policies and practices. Such information may help devise interventions to ensure humane, evidence-based treatment of incarcerated people. PubDate: 2021-05-19
Abstract: Background This study investigates the prisoner and prison-level factors associated with healthcare utilization (HCU) and the dynamic effects of previous HCU and health events. We analyze administrative data collected on annual adult prisoner-stay HCU (n = 10,136) including physical and mental chronic disease diagnoses, acute health events, penal circumstances and prison-level factors between 2013 and 2017 in 4 prisons of Canton of Vaud, Switzerland. Utilization of four types of health services: primary, nursing, mental and emergency care; are assessed using multivariate and multi-level negative binomial regressions with fixed/random effects and dynamic models conditional on prior HCU and lagged health events. Results In a prison setting with health screening on detention, removal of financial barriers to care and a nurse-led gatekeeping system, we find that health status, socio-demographic characteristics, penal history, and the prison environment are associated with HCU overtime. After controlling for chronic and past acute illnesses, female prisoners have higher HCU, younger adults more emergencies, and prisoners from Africa, Eastern Europe, and the Americas lower HCU. New prisoners, pretrial detainees or repeat offenders utilize more all types of care. Overcrowding increases primary care but reduces utilization of mental and emergency services. Higher expenditure on medical staff resources is associated with more primary care visits and less emergency visits. The dynamics of HCU across types of care shows persistence over time related to emergency use, previous somatic acute illnesses, and acting out events. There is also evidence of substitution between psychiatric and primary care. Conclusions The prison healthcare system provides an opportunity to diagnose and treat unmet health needs for a marginalized population. Access to psychiatric and chronic disease management during incarceration and prevention of emergency or acute events can reduce future demand for care. Prioritization of high-risk patients and continuity of care inside and outside of prisons may reduce public health pressures in the criminal system. The prison environment and prisoners’ penal circumstances impacts healthcare utilization, suggesting better coordination between the criminal justice and prison health systems is required. PubDate: 2021-05-13
Abstract: Objective Women on community supervision who inject drugs have significant unmet healthcare needs. However, it remains unclear how the intersection of community supervision and injection drug use influences healthcare experiences and service setting preferences. The present study examines whether the intersection of community supervision and injection drug use is associated with differences in women’s healthcare beliefs, healthcare experiences, and service setting preferences. Methods A secondary analysis was conducted on a previously collected sample of women who inject drugs recruited from a syringe exchange and social service organization for a cross-sectional survey. Participants (N = 64) were mostly White (75%), and more than a quarter were currently on probation or parole (26%). Results Independent samples t-tests and chi-square tests revealed no significant differences on sociodemographic variables by community supervision status. There were no significant differences by community supervision status across seven indicators of healthcare confidence (ps > .05). However, results revealed significant differences in past experiences and beliefs about healthcare, health information seeking, and healthcare setting preferences by community supervision status (ps < .05), where women on community supervision less frequently sought health information and medical care outside of emergency departments. Conclusions Findings provide preliminary evidence about differences in the healthcare experiences and setting preferences of women who inject drugs on community supervision. PubDate: 2021-04-16
Abstract: Background Despite evidence that treatment reduces addiction-related harms, including crime and overdose, only a minority of addiction-affected individuals receive it. Linking individuals who committed an addiction-related crime to addiction treatment could improve outcomes. Methods The aim of this city-wide, pre-arrest diversion program, Madison Addiction Recovery Initiative (MARI) is to reduce crime and improve health (i.e., reduce the overdose deaths) among adults who committed a minor, non-violent, drug use-related offense by offering them a referral to treatment in lieu of arrest and prosecution of criminal charges. This manuscript outlines the protocol and methods for the MARI program development and implementation. MARI requires its participants to engage in the recommended treatment, without reoffending, during the six-month program, after which the initial criminal charges are “voided” by the law enforcement agency. The project, implemented in a mid-size U.S. city, has involved numerous partners, including law enforcement, criminal justice, public health, and academia. It includes training of the police officer workforce and collaboration with clinical partners for treatment need assessment, treatment placement, and peer support. Program evaluation includes formative, process, outcome (participant-level) and exploratory impact (community-level) assessments. For outcome evaluation, we will compare crime (primary outcome), overdose-related offenses, and incarceration-related data 12 months before and 12 months after the index crime between participants who completed (Group 1), started but not completed (Group 2), and were offered but did not start (Group 3) the program, and adults who would have been eligible should MARI existed (Historical Comparison, Group 4). Clinical characteristics will be compared at baseline between Groups 1–2, and pre-post the program within Group 1. Participant baseline data will be assessed as potential covariates. Surveys of police officers and program completers, and community-level indicators of crime and overdose pre- versus post-program will provide additional data on the program impact. Discussion By offering addiction treatment in lieu of arrest and prosecution of criminal charges, this pre-arrest diversion program has the potential to disrupt the cycle of crime, reduce the likelihood of future offenses, and promote public health and safety. PubDate: 2021-03-10
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