Abstract: Background Despite constituting the largest segment of the correctional population, individuals on court-ordered probation remain largely unstudied with respect to hepatitis C virus (HCV) testing and linkage-to-care. We conducted a retrospective, descriptive analysis to estimate prevalence of diagnosed HCV and the subsequent HCV care cascade among a cohort of individuals enrolled in an adult probation program over a 25-month period in Denver, Colorado. Methods We utilized probabilistic matching with first and last name, sex, and birthdate to identify individuals enrolled in probation between July 1, 2016 and July 30, 2018 who had a medical record at the participating safety-net healthcare institution as of December 31, 2019. Electronic medical record data were queried for evidence of HCV testing and care through June 30, 2021. The state HCV registry was also queried for prevalence of reported HCV cases among the cohort. Results This cohort included 8,903 individuals; 6,920 (78%) individuals had a medical record at the participating institution, and of these, 1,037 (15%) had ever been tested for HCV (Ab or RNA) and 308 (4% of those with a medical record, 30% of those tested) had detectable HCV RNA. Of these, 105 (34%) initiated HCV treatment, 89 (29%) had a subsequent undetectable HCV viral load, and 65 (21%) had documentation of HCV cure. Eleven percent of the total cohort had records of positive HCV Ab or RNA tests in the state HCV registry. Conclusions This study demonstrates the importance of HCV screening and linkage-to-care for individuals enrolled in probation programs. A focus on this population could enhance progress towards HCV elimination goals. PubDate: 2022-08-10
Abstract: Background Individuals with substance use disorders (SUD), particularly opioid use disorder (OUD), who are criminal justice-involved are a particularly vulnerable population that has been adversely affected by COVID-19 due to impacts of the pandemic on both the criminal justice and treatment systems. The manuscript presents qualitative data and findings exploring issues related to SUD/OUD treatment among individuals involved in the justice system and the impacts of COVID-19 on these service systems. Qualitative data were collected separately by teams from three different research hubs/sites in Illinois, Indiana, and Kentucky; at each hub, data were collected from justice system personnel (n = 17) and community-level SUD/OUD providers (n = 21). Codes from two hubs were reviewed and merged to develop the cross-hub coding list. The combined codes were used deductively to analyze the third hub‘s data, and higher-level themes were then developed across all the hubs’ data. Results Themes reflected the justice and treatment systems’ responses to COVID-19, the intersection of systems and COVID-19’s impact on providing OUD treatment for such individuals, and the use of telehealth and telejustice. Conclusions Results highlight that despite rapid adaptations made by systems during the pandemic, additional work is needed to better support individuals with OUD who are involved in the justice system. Such work can inform longer-term public health crisis planning to improve community OUD treatment access and linkage for those who are criminal justice-involved. PubDate: 2022-08-04
Abstract: Background Medications for opioid use disorder (MOUD) significantly decrease mortality but courts rarely refer participants with opioid use disorder to MOUD providers. Previous qualitative work suggests routine court referrals to MOUD providers are more likely if court team members perceive providers as “trustworthy.” Court team members may also be less likely to refer participants to MOUD if they consider MOUD unaffordable, particularly in Florida, which has not expanded Medicaid. Our aims were to explore court team members’ 1) perceptions of availability of local trustworthy MOUD providers, 2) characteristics associated with perceptions of availability of local trustworthy MOUD providers, including beliefs about MOUD efficacy, and 3) perceptions of MOUD affordability. Methods An online survey was distributed to all criminal problem-solving court and dependency court team members in Florida in 2019 and 2020. Likert scale questions assessed respondent agreement with statements about the availability of any MOUD providers, the availability of trustworthy MOUD providers, and the affordability of MOUD for court participants. An open-ended question explored MOUD barriers. Spearman’s rho, Friedman, Kruskal Wallis, and Mann-Whitney U tests were used for analyzing quantitative data and iterative categorization for qualitative data. Results One hundred fifty-one respondents completed quantitative questions (26% response rate), and 42 completed the qualitative question. Respondents were more likely to agree that local MOUD providers are more available than trustworthy MOUD providers. Perceptions of trustworthy provider availability differed significantly by MOUD type and were associated with MOUD efficacy beliefs. Qualitative results suggest that MOUD providers offering counseling and individualized treatment are more trustworthy. Conclusions Court team MOUD beliefs may influence their perceptions of providers, or negative experiences with providers may influence court team MOUD beliefs. Improving court team perceptions of local MOUD providers may be critical for facilitating court participant treatment access. PubDate: 2022-07-27
Abstract: Background Despite the limitations the carceral environment may impose on mental wellness, mental healthcare is increasingly becoming a carceral endeavor. Over the course of the last several decades, prisons and jails have become the de facto mental healthcare provider for thousands of incarcerated individuals. Furthermore, practices like mandated mental healthcare for supervised individuals further broaden the population experiencing mental healthcare within the criminal legal system at large. This study examines the perspectives of nine individuals who experienced mental healthcare within the carceral state, whether in prison or on parole or probation, with a special focus on how attributes of the carceral state create ideological and functional barriers to effective mental healthcare. Methods Data for the parent study of this analysis was collected via in-depth, one-on-one interviews of about one hour’s length, conducted at six-month intervals over the course of 2 years. These interviews were analyzed using an iterative process of open-coding, thematic code development, and code application to participant interviews. Results The results showed a common perception of mental healthcare received within the carceral state as serving goals of the prison system, including control and punishment, rather than therapeutic goals of healing and empowerment. This often had negative implications for the quality of the treatment received, including patterns of diagnostic ambiguity, treatment that was ill-fitting to participants’ needs, and treatment that was undermined by the new trauma created by the prison environment. The results also highlighted racial disparities prevalent within the carceral system. Despite the barriers created by the subjection of therapeutic practices to carceral goals, participants demonstrated resourcefulness and creativity in engaging with these treatment modalities to reap benefits where possible. Conclusions Overall, these results highlight the inappropriateness of combining therapeutic and carceral spaces, the need for greater public attention to how carceral mechanisms disadvantage vulnerable populations, and the need for a cultural reconceptualization of mental illness such that it is met not with criminal punishment but appropriate care. PubDate: 2022-07-25
Abstract: Background We are currently witnessing an ongoing drug overdose death epidemic in many nations linked to the distribution of illegally manufactured potent synthetic opioids. While many health policy makers and researchers have focused on the root causes and possible solutions to the current crisis, there has been little focus on the power of advocacy and community action by people who use drugs (PWUDs). Specifically, there has been no research on the role of PWUDs in engaging and influencing mass media opinion. Methods By relying on one of the longest and largest peer-run drug user advocacy groups in the world, the Vancouver Area Network of Drug Users (VANDU), newspaper articles, television reports, and magazines that VANDU or its members have been directly involved in will be identified via two data bases (the Canadian Newsstream & Google News). The news articles and videos related to the health of PWUDs and issues affecting PWUDs from 1997 to the end of 2020 will be analyzed qualitatively using Nvivo software. Discussion As our communities are entering another phase of the drug overdose epidemic, acknowledging and partnering with PWUDs could play an integral part in advancing the goals of harm reduction, treatment, and human rights. PubDate: 2022-07-23
Abstract: Background The lives of women experiencing incarceration are complex, impacting many aspects of parenting. Incarceration can present an opportunity for women to access parenting education. However, their specific needs have to be considered. Few parenting programs for women experiencing incarceration have involved the women as part of their development. Methods Six focus groups were conducted in a prison setting involving thirty-one women to explore and understand their parenting education needs. Results Four main themes were identified to reflect the complex lives of the women and their parenting education needs. These themes were: working towards a positive self, communication as a lifeline, supporting and nurturing their children and hopefulness and reconnecting. The trauma women experienced in their lives was apparent during discussions. Conclusion Women requested a non-judgmental parenting program to be developed to meet their specific needs and circumstances. The program needed to be designed to enable them to share stories with women in similar situations. Women gave insights into some of the specific content and topics they would like included in a parenting program. The women revealed experiences of trauma in their lives, demonstrating the importance of the need for a trauma informed approach to parenting education. PubDate: 2022-07-13
Abstract: Background Fidelity assessment tools can assess whether a program embraces a core set of principles and performs well. A quality fidelity tool with valid scales can be a feedback loop to identify areas that need further work to improve the program. Using data collected from 1816 correctional and reentry programs in the United States in the construction sample and 761 programs in the confirmation sample, this study examined the internal consistency of the Risk-Need-Responsivity (RNR) Program Tool, an online resource to capture information about structural features of a program. Results The study reports on reliability statistics and factor analyses to highlight individual subscales. Six scales emerged and had acceptable to excellent levels of internal consistency. These scales are staffing, reward-and-sanction, clinical standards for programs, coaching, program duration, and risk-need assessment. Conclusions This article discusses fidelity scales from the RNR Program Tool and provides guidance on the importance of tool development processes to ensure accurate, valid, and reliable scales. The purpose of the RNR Program Tool is to create a modern, online tool integrating both the empirical (research) literature on effective practices and clinical standards on quality programming. This process minimizes the need for consultants by giving program administrators the ability to gather information on their programs, score them, and receive instant and targeted feedback with recommendations for improvement to assess their programs against empirical standards in the field. Furthermore, it provides a standardized tool that administrators can use to examine what type of individuals fare better in their programs. The provided targeted feedback can give the programs the ability to seek technical assistance or guidance in specific areas that can strategically strengthen their program. PubDate: 2022-06-09
Abstract: Background The COVID-19 pandemic responses in jails have forced detention officers to adjust how they approach the confinement and care of individuals while they are incarcerated. One aspect of incarceration affected was detention officers’ roles. The aims of this research project were to determine how the COVID-19 pandemic has affected the general duties of detention officers at a Southwest County Jail. Detention officers were recruited via email to participate in an online questionnaire from October to December 2020. Participants answered Likert scale and open-ended questions regarding how the COVID-19 pandemic has affected their job duties. Descriptive statistics and thematic analysis were used to identify themes and patterns in the responses. Results Among 24 detention officers, 87% indicated agreement that the COVID-19 pandemic has significantly changed the duties of detention officers at CCDF. The most discussed change was the introduction of a 14-day quarantine process for newly incarcerated individuals. The 14-day quarantine increased the workload of detention officers. Conclusion The COVID-19 pandemic responses in jail may have unintended negative consequences for the job duties of detention officers. Current and future pandemic response strategies in jails would benefit from taking staff perspectives into consideration as they are directly impacted by the COVID-19 response strategies put into place. Policy implications are discussed. PubDate: 2022-06-04
Abstract: Background Youth experiencing homelessness have disproportionate contact with the criminal legal system. This system contact represents a critical inflection point for enhancing risk or opportunities for stabilization; however, the policy and scholarly traditions examining the criminal legal system have not traditionally incorporated housing or other social determinants as a central focus of intervention. Methods We conducted a scoping review using PRISMA-ScR guidelines to examine how the research literature is currently addressing housing within the context of youth involvement in the legal system. Databases searched included PubMed, Web of Science, and Academic Search Complete. Google Scholar was used to identify papers not indexed in the academic databases of interest. Database searches were conducted between September and December 2019 and articles were restricted to those published in English between the year 2000 and 2019. Key study components extracted included demographic information regarding each sample, type of article, study methodology, direction of effects of interest, outcome measures and primary findings, as well as theoretical frameworks engaged by the authors. Results The search results returned 2154 titles for review. After screening all 2154 titles, 75 met eligibility for inclusion. reviews were conducted for all 75 papers. 36 abstracts met eligibility criteria and underwent full-text review. Ultimately, 29 articles satisfied eligibility criteria and were included in this scoping review. Conclusions Publications are primarily focused on the social epidemiology of risk factors and behaviors determining youth justice contact, but relatively less so on studies of interventions targeting youth delinquency, crime reduction, or recidivism that included housing support. The lack of continuity in theorizing from epidemiology to applied science in this area represents a gap in the literature that is likely reducing the effectiveness of interventions to interrupt patterns of legal system contact for youth. Integrating a public health framework that emphasizes the upstream social determinants leading to contact with the youth justice system would represent a paradigm shift for the field that would have beneficial effects on long term health outcomes for youth. PubDate: 2022-04-08
Abstract: Background Problem-solving courts have the potential to help reduce harms associated with the opioid crisis. However, problem-solving courts vary in their policies toward medications for opioid use disorder (MOUD), with some courts discouraging or even prohibiting MOUD use. State laws may influence court policies regarding MOUD; thus, we aimed to identify and describe state laws related to MOUD in problem-solving courts across the US from 2005 to 2019. Methods We searched Westlaw legal software for regulations and statutes (collectively referred to as “state laws”) in all US states and D.C. from 2005 to 2019 and included laws related to both MOUD and problem-solving courts in our analytic sample. We conducted a modified iterative categorization process to identify and analyze categories of laws related to MOUD access in problem-solving courts. Results Since 2005, nine states had laws regarding MOUD in problem-solving courts. We identified two overarching categories of state laws: 1) laws that prohibit MOUD bans, and 2) laws potentially facilitating access to MOUD. Seven states had laws that prohibit MOUD bans, such as laws prohibiting exclusion of participants from programs due to MOUD use or limiting the type of MOUD, dose or treatment duration. Four states had laws that could facilitate access to MOUD, such as requiring courts to make MOUD available to participants. Discussion Relatively few states have laws facilitating MOUD access and/or preventing MOUD bans in problem-solving courts. To help facilitate MOUD access for court participants across the US, model state legislation should be created. Additionally, future research should explore potential effects of state laws on MOUD access and health outcomes for court participants. PubDate: 2022-03-31
Abstract: Background Internationally, people in prison should receive a standard of healthcare provision equivalent to people living in the community. Yet efforts to assess the quality of healthcare through the use of quality indicators or performance measures have been much more widely reported in the community than in the prison setting. This review aims to provide an overview of research undertaken to develop quality indicators suitable for prison healthcare. Methods An international scoping review of articles published in English was conducted between 2004 and 2021. Searches of six electronic databases (MEDLINE, CINAHL, Scopus, Embase, PsycInfo and Criminal Justice s) were supplemented with journal searches, author searches and forwards and backwards citation tracking. Results Twelve articles were included in the review, all of which were from the United States. Quality indicator selection processes varied in rigour, and there was no evidence of patient involvement in consultation activities. Selected indicators predominantly measured healthcare processes rather than health outcomes or healthcare structure. Difficulties identified in developing performance measures for the prison setting included resource constraints, data system functionality, and the comparability of the prison population to the non-incarcerated population. Conclusions Selecting performance measures for healthcare that are evidence-based, relevant to the population and feasible requires rigorous and transparent processes. Balanced sets of indicators for prison healthcare need to reflect prison population trends, be operable within data systems and be aligned with equivalence principles. More effort needs to be made to meaningfully engage people with lived experience in stakeholder consultations on prison healthcare quality. Monitoring healthcare structure, processes and outcomes in prison settings will provide evidence to improve care quality with the aim of reducing health inequalities experienced by people living in prison. PubDate: 2022-03-07
Abstract: Abstract Several attempts have been made by the global public health efforts and national governments to contain the spread and vulnerabilities to COVID-19. Evidence, however, shows a disproportionate upsurge in COVID-19 cases in correctional facilities such as prisons, particularly, in low- and middle-income countries (LMICs). The poor adherence to COVID-19 preventive protocols in these settings has raised a serious “moral panic” among the public. There are public health concerns about the most effective and state-of-the-art approach to tackling the continuous spread of the virus in prisons. This paper discusses the feasibility of depopulation and vaccination rollouts in combating COVID-19 in correctional facilities with a particular focus on African prisons. The paper proposes selective and strategic depopulation of prisoners, effective prioritization of vaccination among prisoners, and general sensitization of prisoners toward vaccine disbursement in this total institution. PubDate: 2022-03-05
Abstract: Abstract People with opioid use disorders are overrepresented in correctional facilities, and are at high risk of opioid overdose. Despite the fact that buprenorphine/naloxone is the first line treatment for people with opioid use disorder, there are often institutional, clinical, and logistical barriers to buprenorphine/naloxone initiation in correctional facilities. Guided by the knowledge-to-action framework, this knowledge translation project focused on synthesizing knowledge and developing a tool for buprenorphine/naloxone initiation that was tailored to correctional facilities, including jails. This information and tool can be used to support buprenorphine/naloxone access for people in correctional facilities, in parallel with other efforts to address barriers to treatment initiation in correctional facilities. PubDate: 2022-03-02
Abstract: Background The role of rapid testing has proven vital in reducing infection incidence in communities through swift identification and isolation of infected individuals. The COVID-19 pandemic has been particularly catastrophic for residential carceral and rehabilitation facilities that are high-risk settings for transmission of contagious diseases. Centralized provider-based viral testing employing conventional diagnostic techniques is labor-intensive and time-consuming. There is a marked unmet need for quick, inexpensive, and simple viral testing strategies. We hypothesized that rehabilitation residents could successfully test themselves employing inexpensive, disposable, antigen-based influenza lateral-flow tests and would be willing to self-isolate and self-report to health authorities if positive. Methods We evaluated self-testing among 50 rehabilitation residents ages 18 and older in Pomona, California, where participants self-administered influenza lateral-flow diagnostic test (without specimen collection) with the goal of appropriately observing a control line and completed two brief written surveys on self-testing and COVID-19, one before self-administering the lateral-flow test and one after, to determine the overall feasibility of viral self-testing and to characterize attitudes comparing self-testing and provider-based testing. Findings A total of 50 rehabilitation residents were enrolled in this study and all 50 conducted a lateral-flow test and answered the provided surveys. Among the participants, 96% (48 of 50) achieved a positive-control line from their lateral-flow test. Most participants, 83% (34 of 41) indicated that they would prefer to perform their own rapid test instead of having a health care provider administer the test. Notably, 98% (49 of 50) indicated that they would self-isolate if the lateral-flow test returned a positive indicator suggesting the presence of a viral infection and 96% (48 of 50) would report positive results to their corresponding public health department. Interpretation Residents in a residential rehabilitation center were widely able to successfully self-administer standard lateral-flow antigen-based rapid diagnostic kits. Self-testing was strongly preferred over tests administered by a healthcare provider. Reassuringly, almost every resident indicated that they would report any positive test result to the health department and self-isolate accordingly. Self-testing offers a promising adjunct to centralized testing, potentially better enabling swift and effective management of life-threatening infectious outbreaks among those living in high-risk congregate living settings. PubDate: 2022-02-26
Abstract: Background Many law enforcement agencies across the United States equip their officers with the life-saving drug naloxone to reverse the effects of an opioid overdose. Although officers can be effectively trained to administer naloxone, and hundreds of law enforcement agencies carry naloxone to reverse overdoses, little is known about what happens on scene during an overdose call for service from an officer’s perspective, including what officers perceive their duties and responsibilities to be as the incident evolves. Methods The qualitative study examined officers’ experiences with overdose response, their perceived roles, and what happens on scene before, during, and after an overdose incident. In-person interviews were conducted with 17 officers in four diverse law enforcement agencies in the United States between January and May 2020. Results Following an overdose, the officers described that overdose victims are required to go to a hospital or they are taken to jail. Officers also described their duties on scene during and after naloxone administration, including searching the belongings of the person who overdosed and seizing any drug paraphernalia. Conclusion These findings point to a pressing need for rethinking standard operating procedures for law enforcement in these situations so that the intentions of Good Samaritan Laws are upheld and people get the assistance they need without being deterred from asking for future help. PubDate: 2022-02-25
Abstract: Background Women make up 5% of the European prison population on average. Almost invisible in prison and health research, and suffering the stigma associated with female offending, incarcerated women are often forgotten, and their specific healthcare needs remain much ignored. Combining face-to-face survey interviews and medical chart data, we aim to assess the health status, healthcare needs, and access to preventive medicine of women incarcerated in Switzerland. Results Sixty incarcerated adult women participated in a cross-sectional study to assess their life and incarceration histories, physical and mental health problems, medication, and use of medical services. Eligibility criteria were (a) an incarceration of at least four weeks and (b) the ability to provide written informed consent. Exclusion criteria were psychiatric instability and insufficient language competence. Women’s average age was 34.3 years old (SD = 9.8); 45.0% of them were born in Switzerland, 33.3% in Europe and 15.0% on the African continent. Overall, 61.7% of women self-reported physical or mental health problems and 13.3% indicated they were once diagnosed with a sexually transmitted infection. Further, 78.3% of women were active cigarette smokers; more than one in three women reported alcohol use problems and almost one in two women had used at least one illicit drug in the year before incarceration. Depression and perceived stress scores were above clinical cut-off points for more than half of interviewed women. When asked how they rated their health, 68.3% of women felt it had worsened since incarceration. All but four women had accessed prison medical services; however, our study does not indicate whether women’s use of healthcare was indeed adequate to their needs. Conclusions This study demonstrated incarcerated women’s poor health and health-risk behaviours. Structural changes and gender-responsive health promotion interventions have the potential to improve the health of incarcerated women and help them return to the community in better health. PubDate: 2022-02-22
Abstract: Background The purpose of the study was to assess the prevalence of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) and to determine whether TBI or PTSD is associated with an increase in general or violent criminal recidivism among a representative sample of released prisoners. In-person interviews were conducted with a stratified random sample of individuals incarcerated with the South Carolina Department of Corrections approximately 90 days prior to the prisoners’ releases. In addition to a variety of items and scales, respondents were screened for TBI and were asked whether they had received a current diagnosis of PTSD. Data were merged with arrest data that provided measures of past criminal involvement and indicators of post-release recidivism (arrest). Arrests were coded as “general” for any arrest charge and “violent” for any violent offense charge. Results Survival analyses indicate that neither TBI nor PTSD predicts time to general recidivism. PTSD (p < 0.01) and age at first arrest (p < 0.01) are significant predictors for violent recidivism and TBI is non-significant at p = 0.09. Results from the negative binomial models indicate that TBI (p < 0.05) and PTSD (p < 0.05) are significantly associated with more post-release violent arrests, but not general arrests. Conclusions TBI and PTSD were found to predict violent offending but not general criminal behavior. These findings demonstrate the need for prison officials to identify individuals with a history of TBI and PTSD and to develop appropriate interventions that could be provided during incarceration to reduce the post-release likelihood of violence. PubDate: 2022-02-17
Open Access journal
[228 journals]
