Health and Justice最新文献

Background: New Psychoactive Substances (NPS) have become increasingly prevalent in prison environments, serving both social and emotional functions. While research has extensively examined NPS use in the general population, little is known about the specific motivations driving their use among incarcerated individuals. Given the restrictive nature of prison life, substance use motivations may differ from those outside correctional facilities. This study aimed to identify the key motives behind NPS use among prisoners in Poland.

Results: 6 Focus Group Discussions (FGD) with prisoners and 32 individual interviews with staff were conducted in polish prisons and detention centers. Two main categories of motivations were identified: adaptation to prison rules and emotional regulation. The first category included gaining recognition and status among inmates, avoiding legal consequences due to NPS' lower detectability in drug tests, and economic incentives, as NPS serve as a form of currency in prison. Emotional motivations included stress relief, boredom, coping with isolation, family-related distress, and the continuation of pre-incarceration substance use. According to current study prisoners primarily use NPS as a coping mechanism within the prison environment.

Conclusions: Using NPS in prisons allows to better adapt to the specific conditions of prison life and regulate the emotions associated with being in prison. The properties of NPS make them a strong alternative to traditional drugs in prison settings. The findings emphasize the need for prison-specific prevention and intervention strategies that address both the structural and emotional factors contributing to NPS use. Future research should focus on assessing the prevalence of NPS use in correctional settings and evaluating the effectiveness of existing preventive measures.

Purpose: People experiencing homelessness display substantial health inequalities when compared to the housed population. Existing studies on access tend to focus on isolated initiatives within specific geographic contexts, often lacking in comparative analyses. The research aims to address this gap, answering to the question "which types of interventions support access to care for people experiencing homelessness?" and thus providing evidence on the types of interventions that foster access to healthcare services for people experiencing homelessness.

Design: We performed a scoping review of scientific literature published between 2000 and 2023. Included studies focused on interventions improving access to care services for people experiencing homelessness. Qualitative and quantitative data were extracted, and findings were synthesised and assessed against the Levesque framework of access to care.

Findings: Forty-eight studies were included. Healthcare services varied from primary care to outpatient, mental health, prevention, emergency and hospital-based care. Four main types of interventions were determined, answering various access needs. Outreach and community-based interventions were found to ensure available and acceptable responses for people experiencing homelessness; case management and peer support were considered relevant for navigation across and towards services; service integration and coordination efforts were deemed as essential in offering complete responses for multifaceted and complex needs; and digital healthcare interventions proved to make health information more reachable.

Originality: This paper sheds light on the inner complexity of this target population and informs about valuable strategies and approaches that can be pursued when designing and implementing interventions to improve people experiencing homelessness access to care.

The onset of the COVID-19 pandemic posed uniquely dire challenges in New York City's jails. Rates of infection and fatality well exceeded those of the general population as the virus spread through congregate residences, heightening the city's status as an early epicenter. Using an inductive, grounded theory approach, we conduct 12 in-depth interviews with persons incarcerated in these jails early in the pandemic to elicit their perspectives on the carceral system's ability to deliver healthcare services and a safe residence. Participants describe concerns of overcrowding, insufficient protective equipment, and difficulty accessing healthcare through a lens of interpersonal hierarchy, illustrating how their relationships with one another and with jail staff determined their access to public health measures. The data highlight how incarceration revokes individuals' autonomy and imposes a power dependent, hierarchical relational structure. That context complicates or precludes the development of mutual trust needed for effective public health interventions. We posit entrusting external entities with health communication during a disease outbreak as a mitigation strategy.

Youth with fetal alcohol spectrum disorder (FASD) experience complex challenges and may be at an increased risk of contact with the criminal legal system (CLS). However, youth and their families often have strengths and resources that can be leveraged to support positive outcomes. Research in both the FASD and the youth CLS literatures have been predominantly deficit-focused, research that includes strengths and protective factors presents a more balanced perspective and is being recognized as important for youth with FASD. As such, using a directed content analysis guided by the Values in Action (VIA) character strengths framework, the current study explored the perspectives of caregivers regarding strengths and protective factors present in their youth with FASD and CLS involvement. Caregivers reported on 32 independent youth (87.5% male), all of whom had confirmed or suspected FASD and had current or past involvement with the criminal legal system between the ages of 12 and 24. Caregivers mentioned individual-level strengths and protective factors most frequently, followed by relational/familial level factors and broader contextual level factors. Of the individual-level strengths mentioned, over three quarters (76.4%) fell within the VIA character strengths framework. Results suggest that strengths are present in this population across ecological system levels. Findings contribute to a shared understanding of factors that promote overall wellbeing for youth with FASD and CLS involvement from a caregiver perspective. Approaches promoting strengths use may be an advantageous, under-researched method for enhancing well-being in this population.

Background: This scoping review explores how police and health care use digital and algorithm-based alert systems to flag individuals with mental illness. Eight studies were included, covering both police systems and health care-initiated systems to alert law enforcement.

Result: The findings suggest that digital and algorithm-based alert systems can support decision-making and improve police interactions with individuals experiencing mental health issues. However, in health care settings the systems are motivated by workplace safety concerns and in policing from an efficiency perspective, stressing collaborative crisis response between police and health care services. Additionally, information sharing and collaboration between police and health care services benefit from such technology. However, the use of these systems also raises ethical concerns and risks of potential stigmatization.

Conclusion: The review highlights the importance of balancing efficiency and ethical consideration when implementing digital and algorithm-based alert systems in mental-health related policing. Thereto forthcoming studies need to consider if and how frontline policing will benefit from digital and algorithm-based alert systems.

Background: Peripregnant women who use drugs and are involved in the criminal legal system (CLS) face elevated risks of human immunodeficiency virus (HIV) acquisition due to overlapping vulnerabilities, including sexual violence, structural instability, and limited access to preventive healthcare. The unique needs of this population are routinely overlooked in both clinical practice and research. This qualitative study explores peripregnant women's perspectives on HIV risk, attitudes toward pre-exposure prophylaxis (PrEP), and opportunities for PrEP programming in jail settings and during pregnancy.

Methods: We conducted semi-structured qualitative interviews with 27 women in Miami-Dade County who met the following criteria: (1) peripregnancy experience, (2) history of drug use and CLS involvement, and (3) HIV-negative status. Participants were recruited through community-based outreach. Data collection was grounded in trauma-informed methods and community partnership. Data were transcribed and examined through a reflexive thematic analysis, employing a general inductive methodology. Coding was performed through an iterative process by an interdisciplinary team with diverse backgrounds.

Results: There are five major themes: (1) perceptions of HIV risk and risk reduction strategies; (2) knowledge and attitudes toward PrEP; (3) preferences for PrEP delivery modalities; (4) PrEP programming in jail; and (5) perspectives on PrEP use during pregnancy. Women generally viewed PrEP positively, especially long-acting formulations like injectables and implantable devices (in development). However, they also expressed concerns about adherence, stigma, drug interactions, and fetal safety. Jail was identified as a key site for intervention, though participants emphasized the need for confidentiality and robust education.

Conclusions: Findings underscore the urgency of designing patient-informed, context-responsive PrEP interventions that center the lived realities of CLS-involved peripregnant women who use drugs. Prioritizing long-acting PrEP options and integrating services into jail and community-based settings rooted in trauma-informed care and privacy protections can enhance uptake. These strategies are essential to reducing HIV incidence and advancing the goals of the Ending the HIV Epidemic (EHE) initiative.

Police co-responder programs are collaborations between law enforcement and healthcare institutions where behavioral health professionals are embedded within police departments to support officers responding to incidents involving mental health and/or substance use. Research suggests that co-responder programs, which have existed for over 20 years in the United States and have become particularly popular in recent years, have the potential to decrease police use of force and divert individuals experiencing behavioral health crises from the criminal justice system. However, scant knowledge exists about the role of behavioral health professionals in these programs. This qualitative study examines nearly three years of clinical notes from the Boston Police Department's co-response program. Using an inductive approach incorporating aspects of grounded theory and thematic analysis, we analyzed notes from 4,111 co-response encounters between July 2019 and March 2022. Our study yielded a conceptual framework with three domains. First, behavioral health professionals interacted with a wide range of community members, including: police personnel; individuals experiencing behavioral health crises; family members of individuals in crisis; and healthcare and social services providers. Second, and through these interactions, behavioral health professionals assessed behavioral health symptoms, behavioral health history, and indicators of risk. Finally, and in response to their assessments, behavioral health professionals provided clinical supports, police assistance, and general assistance to multiple community members. Our findings suggest potential mechanisms by which co-response programs impact both police and behavioral health outcomes. Implications for practice, policy, and future research are discussed.