Health and Justice最新文献

Background: Harm reduction is a public health approach that emphasizes strategies to reduce the negative consequences of drug use. Rising overdose deaths in the United States have prompted integration of harm reduction strategies within criminal-legal systems (CLS), which have historically emphasized deterrence. However, the scope and nature of these strategies across the CLS remain poorly understood.

Methods: We conducted a scoping review, in accordance with PRISMA guidelines, to identify harm reduction strategies targeting illicit drug use that have been implemented within CLS settings in the United States. We searched seven databases for peer-reviewed articles published in the last 10 years. Eligible articles reported on implementation of a harm reduction strategy focused on reaching PWUD in a CLS setting. Using the Sequential Intercept Model as a guiding framework, we mapped strategies to law enforcement, initial detention/court hearings, jails and courts, reentry, and community corrections settings. We used DistillerSR to screen articles and abstract data.

Results: From 455 records, 99 articles met inclusion criteria, representing 51 discrete instances of harm reduction strategy implementation. Implementation was most common in custody settings (e.g., jails and courts) and frequently included initiation of medication for opioid use disorder, naloxone distribution, and CLS referral/diversion. Fewer instances of implementation were documented in early stage or community-based settings. CLS staff were directly involved in delivering over 75% of the harm reduction strategies, and one-third included partnerships with non-CLS government agencies. Nearly one-third of the strategies were implemented as part of research studies.

Conclusions: Harm reduction strategies have increasingly been integrated into CLS, though unevenly and often with a narrow clinical focus. Expanding harm reduction within CLS will require broader definitions, system-level buy-in, and efforts to align practice with public health evidence.

Background: Non-custodial judicial treatment orders aim to reduce recidivism for justice-involved people with drug and/or alcohol use problems, but health and well-being impacts are not understood. We conducted the first qualitative evidence synthesis to explore the perceived impacts on health and well-being of treatment orders and the perceived barriers and facilitators to implementation from the perspectives of justice-involved adults, their family members/significant others, and staff delivering/ mandating the treatment.

Design: We searched 14 bibliographic databases (31/10/2023-07/11/2023) and conducted supplementary searches to identify qualitative evidence. Two reviewers appraised methodological limitations using CASP and assessed confidence in review findings using GRADE-CERQual. We used framework synthesis to synthesise evidence. We integrated synthesised findings with results of a complementary quantitative review investigating health and well-being effects of treatment orders.

Results: We synthesised 25 studies (29 reports); 22/29 reports had moderate or high methodological limitations. Most studies (n = 20) focused on USA drug courts; none focused on alcohol interventions. Only three studies had health and well-being as their main focus. No studies involved family members. Only one study reported a theory of how treatment orders might impact health. GRADE-CERQual assessments of 13 findings were high (n = 7/13), moderate (n = 4/13), or low (n = 2/13) confidence. Justice-involved adults perceived treatment orders to reduce mortality/morbidity risk, improve sense of self and coping with emotions, to result in feeling healthier, but also to exacerbate trauma and increase stress. Coerced treatment was perceived to interfere with "therapeutic change," nonetheless it was often perceived to reduce, cease and/or stabilise illicit drug use. Justice-involved adults' challenging life circumstances were an important barrier to reducing/ ceasing substance use. Abstinence-based approaches were common but abstinence may be unrealistic. Intervention effectiveness trials rarely measured relational outcomes of importance to justice-involved adults e.g., impacts on their children, or health outcomes.

Conclusions: High-quality qualitative studies are urgently needed on the health impacts of diverse treatments orders. Treatment orders should emphasise harm-reduction treatment approaches and address participants' healthcare and social needs. Theories of how treatment orders work are needed. Unintended negative health consequences of treatment orders must be researched. Future trials should measure and report health and relational outcomes. Study protocol registration: [CRD42023484923]. The National Institute for Health and Care Research (NIHR) Evidence Synthesis Programme (Grant: NIHR153425, project number NIHR162046) funded this study.

Opioid-related fatalities in U.S. correctional facilities present a critical criminal justice and health challenge. This study examines predictors of drug- and opioid-related deaths among incarcerated individuals nationwide. In the main models, younger age increases overdose risk, females face higher odds of drug-related death than males, and shorter stays are linked to all drug-related deaths, while longer stays are associated with opioid fatalities. Geographic disparities emerge, with small metro and micropolitan areas showing higher drug death rates and large fringe metros showing significantly lower opioid death rates. Medium-security facilities and greater spatial distance from public transportation access points predict higher rates for both outcomes. Subgroup analyses reveal that conviction status predicts elevated drug-related mortality only among males and among individuals held longer than 17 days. Notably, over one-third of opioid-related deaths and more than half of other drug deaths occur within 24 h of incarceration, underscoring acute early-stage vulnerability. Findings reveal distinct and overlapping predictors shaped by both rehabilitative and punitive factors, informing policies and interventions to reduce overdose fatalities in jails.

This study examined YouTurn's program, a volunteer-based mentoring initiative for individuals released after completing their full prison sentences in Israel. Unlike parolees, this group generally lacks structured transitional and healthcare support, risks of adverse health outcomes, and recidivism. Drawing on semi-structured interviews with mentors, staff, and institutional partners involved in the program, the study employed thematic analysis to explore the program's strengths, challenges, and broader implications. Findings indicate that YouTurn's civilian volunteer mentors deliver holistic support that addresses emotional, social, and practical reentry needs, while fostering organizational cohesion and continuity during crisis. The program's distinctive reliance on civic volunteers offers an alternative model of support rooted in community commitments, positioning YouTurn as a strengths-based intervention that fills gaps in current rehabilitation policy. Respondents also indicated significant challenges, including participants' dropout, limited resources, and a lack of diversity among mentees. The study extends theoretical understandings of mentoring models and demonstrates the potential of civic volunteer-driven initiatives to complement peer- and professional-based approaches in offender rehabilitation.

Background: Prisons are well understood to be hotspots of the COVID-19 pandemic. Yet, little is known about the impacts the COVID-19 pandemic has had on pregnant and postpartum people in prison. We conducted a secondary analysis of 63 semi-structured qualitative interviews (December 2021-May 2023) with subject matter experts, primarily perinatal program staff working in prisons, to better understand how perinatal support programs for people in prison were impacted by the COVID-19 pandemic.

Results: We identified nine themes in interviews as impacting perinatal support programming for incarcerated pregnant and postpartum people during the COVID-19 pandemic: 1) prison COVID-19 preventative practices and their influences on perinatal support programs; 2) COVID-19 quarantine and confinement of pregnant and postpartum people; 3) changes in the pregnant and postpartum population and reentry support; 4) changes to birth support during incarceration; 5) lack of communication and inconsistency between the DOC and perinatal support programs; 6) DOC staffing and staff turnover; 7) lack of access to volunteer-led programming and visiting; 8) relationships between perinatal support programs and DOC healthcare providers; and 9) relationships between perinatal support programs and hospitals. Results were organized into a modified socioecological model, allowing us to view different spheres of influence, how they interact and overlap, and as we describe in the discussion section, where practitioners and policy-makers might intervene. In particular, we focused on the organizational, relational, and structural levels, with multiple themes organized into each level. All of these themes, together, help provide information on how the COVID-19 pandemic impacted perinatal support programs in prisons.

Conclusions: The COVID-19 pandemic had drastic impacts on prison operations and perinatal support programs, with cascading influences on the health and wellbeing of pregnant and postpartum people who are incarcerated. We conclude with a series of recommendations, developed by the research team and a community research council of formerly incarcerated individuals, that aim to address pandemic-related health disparities and promote health equity among those disproportionately impacted by the COVID-19 pandemic.

Background: Criminal legal involved (CLI) individuals face a heightened risk of opioid misuse and overdose, yet access to medications for opioid use disorder (MOUD) is limited, particularly in criminal legal settings. Negative attitudes and misinformation about MOUD are prevalent among legal system actors, creating a barrier to MOUD access. This study examines the effectiveness of informational and narrative messages in correcting misinformation and promoting positive attitudes toward MOUD among criminal legal system (CLS) professionals.

Method: Using state/federal websites, social media groups, and professional connections to correctional and behavioral health agencies nationwide, we recruited individuals who were currently working in corrections and behavioral health in criminal legal settings in the United States (N = 502). An online experiment was conducted with four message conditions: no message control, informational message, first-person narrative message, and dialogue message. The study assessed attitudes toward MOUD use and support for greater access in these settings, as well as information processing outcomes including narrative transportation (i.e., becoming immersed in a story), perceived realism, and counterarguing.

Results: Compared to no message control, both the first-person narrative message (p = .006) and the dialogue message (p = .026) produced more positive attitudes toward MOUD; the informational message marginally improved positive attitudes (p = .080). The dialogue message also increased support for MOUD access in jails/prisons compared to control (p = .003). Neither the narrative nor the informational messages significantly reduced negative attitudes. The first-person (p = .050) and dialogue (p = .030) messages both generated significantly greater transportation compared to the informational message.

Conclusion: Both informational and narrative messages can improve attitudes toward MOUD use in criminal legal settings. Well-designed educational messages aimed at changing attitudes and reducing barriers to promoting MOUD use in criminal legal settings are warranted.