Health and Justice最新文献

Background: In 2018, in response to a lawsuit and years of civil society advocacy for prison-based syringe distribution due to elevated rates of injection drug use, HIV, and hepatitis C virus among incarcerated people, the Correctional Service of Canada (CSC) developed a Prison Needle Exchange Program (PNEP). Implementation of the PNEP has been slow and has faced significant critiques and challenges. As of early 2025, the PNEP is only available at eleven of forty-three federal prisons in Canada. Employing realist review methodology, an iterative process for synthesizing evidence concerning complex policy interventions, this article investigates CSC's approach to, and implementation of, the PNEP. By recognizing broader social and institutional contexts, and through the integration of environmental considerations, realist reviews consider policy outcomes and implications in addition to efficacy. In our study, we draw upon 114 distinct documentary sources, comprised of scholarly articles, news media, program evaluations, and correctional policies, as well as 257 pages of federal government disclosures acquired through Access-to-Information requests. Together, these allow us to identify factors that have either facilitated or impeded the PNEP's ongoing rollout and uptake among people in prison.

Results: Our results find that perceived risks regarding the circulation of needles and the use of a "Threat Risk Assessment" to determine eligibility function as major impediments to program efficacy. Findings also reveal incarcerated people seeking to enroll in the PNEP are frequently denied access and that the active involvement of correctional officers in enforcing compliance to program requirements acts to the detriment of participation. Results indicate the absence of meaningful confidentiality protections along with elevated rates of program discontinuation. Over roughly seven years of its existence, the PNEP has had extremely low uptake, particularly among women.

Conclusions: We propose a significant revisioning of CSC's PNEP to bring it into alignment with the best practices of similar prison-based harm reduction initiatives internationally, and according to professionally accepted standards of syringe distribution. The Canadian experience provides a cautionary tale to other jurisdictions considering implementing a carceral syringe program.

Youth involved in the juvenile justice system (YIJ), including those under community supervision, have disproportionately high rates of behavioral health disorders compared to community samples, yet the vast majority do not receive the care they need. When left unaddressed, youths' behavioral health concerns can contribute to deepening juvenile justice involvement, which is frequently accompanied by increasing severity of behavioral health disorders and negative long-term ramifications for youth, families, and communities. The majority of YIJ are under community supervision, meaning they reside in the community and must receive behavioral health treatment through the community-based behavioral health system. To highlight the need for innovative approaches that break this cycle by closing the gap between clinical need and uptake of effective treatment for these high-risk and often overlooked youth, we synthesize existing literature on the prevalence of psychiatric disorders and intersecting domains of risk for disorder and justice involvement among youth under community supervision, drawing on ecodevelopmental and ecological systems theory to advance an understanding of specific barriers to services for youth under community supervision. We review existing efforts to facilitate treatment access and conclude with data-driven recommendations for future research, clinical practice, and policy changes.

Background: This paper describes COVID-19 cases in the Northern Ireland (NI) prison population during the pandemic in relation to the general population and changes implemented to control infection in NI prisons. Data obtained from the Department of Justice and Department of Health (week ending 22nd May 2020 to week ending 8th April 2022) are presented using descriptive statistics. An account based on information about meetings, activities, routines and processes in prison during the pandemic was gathered mainly via an interview with a Healthcare in Prison staff member. This narrative was refined following feedback from the lead Northern Ireland Prison Service (NIPS) liaison person to provide an overview of infection control measures, adaptations and cases.

Results: Strict infection prevention and control measures introduced in NI prisons, such as screening on entry and isolation periods, restricted access, halting all non-essential activities and providing additional wash stations were successful in minimising the onset and spread of COVID-19. The integrated NIPS-HiP approach appeared to prevent COVID-19 infections for most of the pandemic, and the waves of peak infection that characterised spread in the general population were not evident in the prison population. This management approach in prisons was characterised by multiagency partnership involving the NI Public Health Agency, joined-up planning and collaborative working.

Conclusions: This study describes the implementation of infection control measures in NI prisons during the COVID-19 pandemic and contributes to our understanding/planning about the prevention and management of similar scenarios in the future.

Background: Recognizing the disparate health status of correctional populations compared to the general population, national agencies have called for research to better understand disease epidemiology and healthcare needs of individuals in jails. This paper introduces the Registry of Electronic Archives in Correctional Healthcare (REACH) database - a largescale, multivariable living database derived from electronic healthcare records (EHR) of individuals discharged from jails across the nation beginning in 2013. We describe methods used to secure data, detail current database contents, and offer an initial presentation of sample demography. To demonstrate REACH's utility, an investigation of factors contributing to length of stay (LOS), including demography, health status, and jail characteristics, was conducted.

Results: The current REACH sample (N = 1,251,837) is primarily comprised of males (72.0%) identified racially as White (55.3%) in their mid-30's. While detained, approximately 20% and 17% of individuals were prescribed treatment for chronic medical and/or mental health conditions, respectively. Multilevel modeling was used to examine if sex, race, health condition, and/or jail location or size predicted LOS.

Conclusions: By accessing EHR data, we can expand our understanding of assessment and treatment of specific healthcare conditions in jail populations and address complicated questions about health status of detainees. Data analysis using the REACH database suggests LOS is influenced slightly by jail characteristics and more substantively by detainee demography and medical/mental health conditions. We propose the REACH database's potential for answering important questions about health status and healthcare services for jail populations, including questions about epidemiology and correctional healthcare.

Background: Intimate partner violence (IPV) disproportionately affects Black women who use drugs and those mandated to community supervision programs (CSPs). Societal responses to minoritized identities such as being a woman who has sex with women and men (WSWM) and using substances further increases the risk. This study sought to 1) identify patterns of IPV perpetrated by male partners and 2) examine membership to latent classes and associations to WSWM and other sociodemographic and psychosocial factors. This is a secondary data analysis using baseline survey data from the E-WORTH randomized control trial (2015 - 2019) that evaluated the effectiveness of an HIV/STI intervention for Black women who use drugs mandated to CSPs (n = 272). Descriptive and bivariate analysis were used to describe psychosocial and sociodemographic factors. Latent class analysis was conducted on responses to the Revised Conflict Tactics Scale lifetime psychological, physical, injurious, and sexual items, to identify latent classes of women who experienced IPV.

Results: Forty-one percent (n = 144) of the sample were WSWM, 89% of whom experienced lifetime IPV. WSWM experienced significantly higher rates of all types of IPV. LCA revealed a two-class solution was the best fit: Class 1 (High Psychological/Low-Moderate Other IPV) and Class 2 (High Psychological & Physical IPV/Moderate Injurious & Sexual IPV). Two thirds of the sample were members of Class 2 and had an overall moderate to high probability of experiencing each type of IPV. WSWM, any lifetime illicit drug use, childhood physical or sexual abuse, and lifetime experience of police sexual misconduct were associated with higher odds of membership to Class 2, compared to membership to Class 1.

Conclusion: Experiencing minoritized identities and related psychosocial factors is associated with higher rates of all types of IPV. Inclusive IPV services are needed to engage Black WSWM who use drugs within the criminal-legal system.

Background: In an effort to address health risks for HIV among justice-involved individuals, linkage to community services for HIV and substance use disorder prevention and treatment is critical. Stakeholder feedback informing the development of interventions aimed at linking individuals to care is paramount to ensuring the success of the intervention. The current study examines focus group data collected as part of a 5-year NIDA-funded project and presents this data within an implementation science framework.

Methods: Six focus groups were conducted across four communities in two states. A total of 19 individuals representing 15 agencies, including both corrections and community healthcare providers, participated in the focus groups. A deductive coding strategy was used to code the focus group transcripts using Atlas.ti 9 software. Audio-recorded interviews were transcribed and coded by trained qualitative researchers.

Results: The resulting 1,485 quotes were queried and analyzed using the EPIS inner and outer contexts implementation framework for reporting the findings. Inner context themes encompassing organizational characteristics, staffing processes, and leadership highlight the importance of intra-agency communication, as well as the benefit of hiring peer navigators with lived experience. Outer context themes of interest include funding, sociopolitical context, and interorganizational networks, pointing to service barriers related to funding for PrEP and HIV care, legislative regulations, and the importance of communication to connect people with justice involvement to healthcare and other services.

Conclusions: Results support the use of both patient navigation and mobile health unit models to connect justice-involved individuals to healthcare. The themes that emerged during the focus groups helped inform the ACTION study protocol, and the focus group process bolstered the connection between the represented agencies. Ultimately, these focus groups provided valuable information about the communities participating in the study and provided key insights regarding study intervention implementation.

Trial registration: ClinicalTrials.gov, NCT05286879. Registered 25 February 2022. https://clinicaltrials.gov/study/NCT05286879 .

This paper will review the state of the science on maternal health and incarceration. We will provide a historical context on women, pregnancy, and mothers as it relates to mass incarceration, considering both structural racism and reproductive justice. We will discuss existing research that documents care, treatment, and outcomes of individuals who are incarcerated while pregnant or postpartum in the United States. We will discuss the implications of carceral exposure on birthing people and their families. By synthesizing current research and relevant policies, we will identify gaps that will then inform a research agenda for the next decade, including methods and content, to address inequities in and improve maternal and infant outcomes among pregnant and parenting people exposed to incarceration.

Background: There is a strong relationship between mental health and female offending, but few studies use longitudinal data to capture the differences in mental health service contact and diagnoses across diverse female offending trajectories. Most studies focus on broad trends, often overlooking how mental health contacts and diagnoses differentially unfold across female offending trajectories. We address this gap by utilising state-wide, linked administrative data for all females registered as born in Queensland (Australia) in 1983 and 1984 to examine the prevalence, timing, and frequency of mental health service contact and diagnoses across distinct female offending trajectories, including comparisons with non-offending females.

Results: Females with serious and persistent offending patterns were more likely to have contact with mental health services and receive earlier and more frequent mental health diagnoses than those with low or non-offending patterns. Additionally, females with adult-onset offending patterns were more likely than any other group to contact mental health services before their first recorded offence. Despite a decrease in mental health-related hospital admissions by late adolescence, all offending groups experienced a rise in community mental health contacts as they transitioned into adulthood.

Conclusions: This study expands existing evidence by providing insight into the relationship between mental health and female offending trajectories. Our study also provides important implications for policy and practice to improve the mental health and well-being of females involved in the justice system.

Background: The criminal legal system (CLS) provides a critical intervention point for women at high risk for overdose, and the need continues to rise as the number of incarcerated women increases. Effective, targeted prevention interventions to reduce overdose risk for CLS-involved women are needed, such as naloxone distribution. This study describes the overdose education and naloxone distribution (OEND) procedures used in the Kentucky-hub of the Justice Community Opioid Innovation Network (JCOIN).

Method: Participants included women incarcerated in nine Kentucky jails (N = 900) who were randomly selected, screened for opioid use disorder, and consented for the study. They were followed three-months following jail release to examine naloxone utilization and overdose experiences.

Results: Study findings indicate that about three-quarters (74.4%) of women in this study reported lifetime injection and more than half (54.9%) had a lifetime history of a non-fatal overdose prior to entering jail. About 70% of women reported receiving a study naloxone unit upon jail release, and of those, 30 women reported using the unit during the three-month post-release window. About 4% of the sample reported a non-fatal overdose during this same time period.

Conclusions: Incarcerated women in this sample reported a history of behaviors that may signal overdose risk upon release to the community such as injection drug use and non-fatal overdose. Study findings suggest targeted OEND efforts for women in general are desperately needed, and particularly among women at highest risk during community re-entry.