Health and Justice最新文献

Background: Implementation science (IS) is an emerging discipline that offers frameworks, theories, measures, and interventions to understand both the effective organizational change processes and the contextual factors that affect how well an innovation operates in real-world settings.

Results: In this article, we present an overview of the basic concepts and methods of IS. We then present six studies where IS was used as a means to understand implementation of a new innovations designed to improve the health and well-being of individuals under criminal legal system supervision.

Conclusion: We discuss how IS has developed new knowledge on how to implement efficacious innovations and suggesting future research needed to further our understanding of implementation and sustainability of innovations in the legal context.

Background: Existing evidence elucidates the psychological dimensions of juvenile delinquency, yet the need for cross-cultural validation remains critical to deepen and diversify our understanding of delinquency across different settings. Properly assessing and addressing the mental health needs of youth involved in the justice system (YIJS) is a strategic step that can help design and implement comprehensive responses to produce healthier youth who are less likely to act out and commit crimes. To this aim, this study explored several key mental health dimensions among YIJS who were incarcerated in rehabilitation centers located in Jordan.

Methods: A paper survey was used to collect data from YIJS who were incarcerated in five rehabilitation centers located in three major provinces in Jordan [Amman (n = 89, 59%), Irbid (n = 50, 33%), and Zarqa (n = 12, 8%)]. A total of 158 YIJS (98% boys) completed the study questionnaire, which included sociodemographic and health measures, as well as measures assessing adolescent depression, anxiety, self-esteem, academic stress, and family relationships.

Results: Among the surveyed Jordanian YIJS, 36% reported frequent suicide ideation, 57% experienced moderate to severe depressive symptoms, and 13% displayed elevated anxiety levels, while 47% faced high stress levels primarily due to academic pressures. Further, 7% had a family member who attempted suicide, and 5% had a family member who died by suicide. Poor family dynamics were also revealed among YIJS, with about 41% feeling a lack of cohesion, 60.3% encountering frequent conflicts, and 32.8% feeling restricted in expressing themselves openly within their families. Almost 82% reported scores indicating normal self-esteem, 10% low self-esteem, and 8% high self-esteem. Participants with high self-esteem exclusively reported theft, whereas drug use was the most common offense among those with low self-esteem. Depression scores were significantly related to self-esteem and educational stress scores.

Conclusions: Jordanian YIJS are particularly vulnerable and under studied population. This study assists with addressing a critical evidence gap concerning the mental health needs of incarcerated youth residing outside the regularly studied context of high-income countries. The findings call for a comprehensive, culturally adapted approach that includes enhancing the juvenile justice system's focus on mental health services, educational support, and family engagement. Our study supports the adoption of the National Strategy for Juvenile Justice (2024-2028), which aims to foster a more rehabilitative and child-friendly justice system in Jordan. This approach not only aligns with global human rights standards but also addresses the specific needs and circumstances of Jordanian youth, promoting their overall well-being and reducing recidivism.

Background: To inform the feasibility and acceptability of evidence-informed police practices related to substance use, addiction, and overdose, we sought to better understand how US police chiefs perceive substance use and related policing practices.

Methods: A national sample of randomly selected US police chiefs (N = 276) completed a 37-item survey about substance use and policing. Nine items assessed chiefs' perceptions of: officers' discretion in making arrests, effectiveness of overdose responses, risks of fentanyl exposure, de-escalation practices, harmful drugs in their community, and illicitly-obtained buprenorphine. Data were analyzed with descriptive statistics and exploratory ordinal logistic regressions.

Results: Most chiefs (72.5%) agreed that arrest for any nonviolent misdemeanor was at the discretion of their officers, and they overwhelmingly (94.9%) trusted their officers to make the right arrest decision. The majority of chiefs (87.7%) felt their officers could effectively respond to an opioid overdose, and 83.7% reported their officers carried naloxone on patrol. Chiefs in the Northeast were significantly less likely to be confident in their officers' ability to respond to a methamphetamine overdose than chiefs in the West. Most (90.0%) were receptive to implementing methamphetamine de-escalation strategies (i.e., techniques to resolve crises short of force). Almost all chiefs (91.2%) agreed with the inaccurate statement that fentanyl exposure at a drug overdose scene could harm officers.

Conclusions: Police chiefs express interest in several types of evidence-based public health approaches to policing. Critically, there is a need to curtail fentanyl misinformation and to improve officer knowledge about medications for treating opioid use disorder.

Over 20 years has passed since the principles of gender-responsive correctional strategies were published in a foundational report in the U.S. These practices acknowledge the unique characteristics and life experiences of justice-involved women, have undergone rigorous empirical testing, and are shown to effectively reduce women's recidivism. In part, they supported the United Nation's adoption of minimum human rights afforded to women serving custodial and non-custodial criminal sentences. This paper presents updated research evidence that continues to amplify the need for gender-responsive principles and practices, including the role of victimization in girls' and women's offending trajectories and the intersection of relationships, relational identity, and trauma as key drivers for justice involvement. Further, because the perinatal needs of justice-involved women are a frequently overlooked area of inquiry among the gender-responsive literature, this scholarship is also summarized using a reproductive justice framework. Finally, we illustrate the impact of gender-responsive scholarship by sharing some of the practice and technology innovations that have emerged, while acknowledging there is much yet to accomplish.

Background: People working in the criminal justice system face substantial occupational stressors due to their roles involving high-risk situations, trauma exposure, heavy workloads, and responsibility for public safety. Consequently, they have a higher prevalence of mental health problems than the general population. Employees identifying as women, Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer, Intersexual, Asexual, and all others (2SLGBTQIA+), or Black, Indigenous, and People of Color (BIPOC), may experience additional stressors due to discrimination, harassment, and systemic barriers to seeking and receiving support. Psychoeducational and psychosocial programs have shown mixed effectiveness for preventing or reducing occupational stress, emphasizing the urgent need for multi-level, comprehensive, system-wide approaches. This scoping review aimed to capture and consolidate recommendations from strategies, frameworks, and guidelines on supporting the psychological health of criminal justice workers.

Results: The scoping review of 65 grey and 85 academic literature records presents recommendations aimed at improving the psychological health and safety of criminal justice system workers. Findings were mapped by occupational groups to the Social-Ecological Model and accounted for factors across the individual, interpersonal, institutional, and policy levels. The most common recommendation across all criminal justice occupational groups was workplace mental health training to reduce stigma, encourage help-seeking, prepare workers for traumatic incidents, and promote culturally responsive approaches. At the individual level, physical health, healthy lifestyle choices, and coping strategies were widely recommended. Interpersonal interventions, including peer support and models emphasizing wraparound care, were also recommended. Institutional factors such as fair workloads, safe working conditions, and harassment-free workplaces were emphasized. At the policy level, presumptive coverage policies and adequate funding for staffing needs were highlighted.

Conclusion: This scoping review captured intersecting strategies and recommendations, consisting primarily of individual- and institutional-level supports and services. Fewer records discussed the need to address structural and policy considerations such as labor shortages, patchy mental health benefits, underfunding, and discrimination. The review highlights the need for shared responsibility across different levels, providing a framework for improving the psychological health and safety of criminal justice workers.

Background: In 2018 Massachusetts mandated that county jails offer all FDA-approved medications for opioid use disorder (MOUD) to incarcerated individuals with OUD. Estimating costs needed to implement and sustain an MOUD program are not clearly known in jail facilities. The objective of this study was to identify the type of MOUD model deployed by the jails serving as research sites for the Massachusetts JCOIN hub, determine which resources were utilized at each stage of development, and estimate the associated costs.

Methods: Resources required to implement and sustain the MOUD programs were identified through detailed, site-specific microcosting analyses at six participating jails in Massachusetts. Quantitative resource utilization data were captured primarily through in-person site-visits and semi-structured interviews with key personnel. Unit costs were derived from the Federal Supply Schedule and Bureau Labor of Statistics from a site-specific level perspective. Our customizable budget impact tool, designed to assist jails/prisons with assessing the viability of alternative MOUD models, was used to organize each site's resources and estimate their associated costs. Resources/costs were summarized by site, according to type and phase, and cross-site comparisons were made to identify common program elements and unique models.

Results: Three MOUD models were identified. Model 1 consisted of a vendor hired to deliver and administer methadone daily, while clinical jail staff administered buprenorphine and extended-release naltrexone. Model 2 included facilities that hired a certified vendor to operate an in-house opioid treatment program (OTP) to oversee the administration of all MOUD. Jails in Model 3 became certified OTPs, thereby allowing jail staff to manage all aspects of the MOUD program. There was considerable variability in implementation costs, both within and across models, driven by model-specific factors, but also with switching models, expanding infrastructure, etc. Entering the sustainment phase, the per-person costs of care were quite similar across models but differed according to the proportion of costs considered time-dependent vs. variable.

Conclusion: Our findings represent the most detailed and comprehensive estimates of resource/cost requirements for jail-based MOUD programs. Given the budget constraints faced by jails, the investment required to implement/sustain an MOUD program will likely result in the need to obtain additional funding or reallocate existing resources away from other initiatives.

The opioid overdose crisis intersects critically with the criminal legal system where individuals with opioid use disorder (are significantly overrepresented. Subsequently, incarceration increases the risk of opioid overdose due to reduced tolerance, interrupted social supports, and limited access to treatment. Medications for opioid use disorder (MOUD), such as methadone, buprenorphine, and naltrexone, have been shown to reduce opioid-related mortality and improve outcomes for those in carceral settings. Despite this, access to MOUD in jails and prisons remains limited due to stigma, concerns about medication diversion, and logistical challenges. This paper reviews the current state of knowledge on MOUD in carceral settings, summarizing the prevalence of treatment programs, the role of novel formulations like injectable buprenorphine, and barriers to implementation. It also explores the continuum of care, emphasizing the importance of initiating MOUD during incarceration and ensuring continuation upon release to prevent treatment gaps. Recent policy changes, such as Sect. 1115 Medicaid waivers, offer promising avenues for expanding access, but retention in treatment and post-release outcomes remain significant challenges. The paper provides a comprehensive overview of existing literature and updates on MOUD service delivery, including the impact of recent policy shifts and research on outcomes such as recidivism and health improvement. It concludes by identifying key areas for future research, including strategies to improve treatment retention, address systemic barriers through criminal justice reform, and enhance care coordination during the transition from incarceration to the community.

Background: Substance use disorder affects over half of incarcerated individuals, with 23% experiencing opioid use disorder specifically. Addressing opioid use disorder in jails is crucial due to its association with increased recidivism and overdose. This study investigates the experiences of peer recovery specialists working with individuals with opioid use disorder and criminal justice involvement, focusing on barriers and facilitators to client connections. Qualitative interviews were conducted and thematically analyzed using a hybrid inductive and deductive coding approach. The sample involved five peer recovery specialists, who were interviewed multiple times, across three sites in Virginia between August 2022 to December 2023.

Results: This analysis categorized findings into two main domains: barriers to connection and facilitators of connection. Within the barriers to connection, six themes emerged: jail specific restrictions, client in withdrawal, social determinants of health insecurities, lack of client engagement, disconnection, and adverse peer recovery experience. Jail-specific restrictions was the most common barrier to connection with 91.30% of transcripts referencing at least one code for jail-specific restrictions; 73.91% of all transcripts indicated social determinants of health insecurities; 56.52% of all peer recovery specialist transcripts experienced clients in withdrawal; 52.17% of all transcripts identified lack of client engagement; 43.48% of all transcripts identified disconnection as a barrier; and 34.78% of all transcripts indicated adverse peer recovery specialist experiences. Three themes were identified as facilitators of connection: peer communication skills, connection to services, and positive peer recovery specialist experience. Peer communication skills were by far the most prominent, with 100% of all transcripts indicating a code related to peer communication skills; 60.87% of all transcripts indicated positive peer recovery specialist experience; and 56.52% of all transcripts identified connection to services as a facilitator. Notable discrepancies in code frequency were observed across different sites, suggesting site specific challenges.

Conclusion: This study offers valuable insights into enhancing peer-based support programs within the justice system for individuals with opioid use disorder. Barriers such as jail specific restrictions, client withdrawal, and social determinants of health insecurities pose significant challenges, while effective communication emerges as a critical facilitator. Findings emphasize the need for collaborative efforts between justice and recovery partners to optimize the impact of peer-based support services.

Background: During the COVID-19 pandemic, governments worldwide introduced law enforcement measures to deter and punish breaches of emergency public health orders. For example, in Victoria, Australia, discretionary fines of A$1,652 were issued for breaching stay-at-home orders, and A$4,957 fines for 'unlawful gatherings'; to date, approximately 30,000 fines remain outstanding or not paid in full. Studies globally have revealed how the expansion of policing powers produced significant collateral damage for marginalized populations, including people from low-income neighboorhoods, Indigenous Peoples, sex workers, and people from culturally diverse backgrounds. For people who use drugs, interactions with police are commonplace due to the criminalization of drug use, however, little empirical attention has been given to their experiences of pandemic policing; we aimed to address this gap in the literature.

Methods: We conducted a mixed methods study involving participants of two prospective observational cohort studies of people who use drugs (n = 2,156) in Victoria, Australia, to understand impacts of the pandemic on their lives. Between 2020 and 2022 pandemic-related questions were added to survey instruments; during this period, 1,130 participants completed surveys. We descriptively analyzed the data of participants who reported police interactions related to pandemic restrictions (n = 125) and conducted qualitative interviews with 89 participants. Qualitative data were analysed thematically and integrated with quantitative results.

Results: 11% (n = 125) of survey respondents reported pandemic-related interactions with police; most (26%) were for breaching curfews and 30% received COVID-19 fines. Qualitative interviewees observed increased policing in street-based drug markets and local neighborhoods; many felt harassed and believed policing practices were targeted and discriminatory. Thirty-eight interviewees received COVID-19 fines; some were fined while homeless or travelling to or from harm reduction services. All lacked the financial means to pay fines, resulting in fear of additional criminalizing effects such as additional financial penalties, court orders, criminal convictions, and incarceration; for some fears became a reality.

Conclusion: Our study demonstrates how public health emergency responses centred around policing and criminalization exacerbated harms for people who use drugs, with detrimental effects enduring beyond the pandemic. Results provide insights for future public health emergencies, including highlighting the need for responses that protect, rather than abrogate the health and safety needs of marginalized and criminalized groups.

Background: The number of older adults entering the criminal justice system is growing. Approximately 8% of older prisoners in England and Wales have suspected dementia or mild cognitive impairment (MCI) and experience difficulties in everyday functioning, and disruption to their daily life. At present, no specific dementia/MCI care pathway has been implemented that is applicable and appropriate for use across different prisons in England and Wales. The aim of this paper is to explore the experiences of older adults with dementia/MCI in prison, and a range of key stakeholders, around the day-to-day issues faced by people with dementia/MCI and prison, healthcare, and third sector staff regarding the delivery of support for individuals with dementia/MCI.

Methods: Thirty-two semi structured interviews were conducted with prison, local authority, and healthcare staff; peer supporters; third sector care providers; and individuals with dementia/MCI themselves, across five establishments, to provide multidimensional perspectives of dementia/MCI in criminal justice settings. The data obtained during interviews were thematically analysed.

Results: From the data, six key themes emerged: (I) ethical concerns around trial, sentencing and detainment for people with dementia/MCI; (II) An unforgiving prison system, providing physical and social environments incompatible with supporting individuals with dementia/MCI; (III) An unprepared workforce requiring training in dementia/MCI. (IV) A lack of collaboration leading to sub-optimum management of the support needs of people with dementia/MCI in prison; (V) Peer support 'plugging the gap'; and (VI) staff 'hands tied behind back'.

Conclusions: Results point towards a pressing need to develop more appropriate support systems for individuals with dementia/MCI throughout the criminal justice system. Ethical concerns around the judicial process for individuals with diminished cognitive capacity must be considered. Prison governors should examine ways to make the living environment more appropriate for these individuals, and a joined-up collaborative approach to health and social care should be adopted. Staff must be appropriately trained to support and identify individuals with dementia/MCI. Peer support schemes require formal evaluation, and training/oversight of these schemes should be comprehensive.