Health and Justice最新文献

Background: Worldwide, the prevalence of mental health problems in prison populations is higher than in the general population. While prisons may provide opportunities to address mental health problems, the prison setting can also include obstacles to the actual delivery of interventions, such as mental health care staff deficiencies. A brief scalable psychological intervention such as the World Health Organization's (WHO) Problem Management Plus (PM +) intervention, which is delivered by trained non-specialists, could be valuable in addressing common mental health problems in the prison setting. The primary aim of the study is to evaluate the feasibility and acceptability of PM + , adapted for use in Dutch remand prisons. The secondary aim is to examine barriers and facilitators for scaling up the adapted version of PM + in the Dutch prison setting.

Method: This single-blind pilot randomised controlled trial (RCT) will compare individual PM + with care-as-usual (PM + /CAU) to CAU only. Dutch-speaking remand prisoners (18 years or older; N = 60) who report an elevated level of psychological distress (K10 ≥ 16) will be included. The feasibility of the intervention will be reviewed using different measures such as recruitment success, intervention retention, protocol adherence, number of serious adverse events, and stakeholders' views. Participants will be assessed for self-reported anxiety, depression, self-identified problems, vulnerability for suicide and self-harm behaviour and post-traumatic stress disorder (PTSD) symptoms at baseline, one-week post-intervention and three-month follow-up. The pilot RCT will be followed by a process evaluation. For the process evaluation, stakeholders will be interviewed (N = 25), including 1) RCT participants, 2) PM + helpers, supervisors and trainers, 3) prison professionals, and 4) family members & friends of RCT participants. Data of the process evaluation will be analysed using reflexive thematic analysis.

Discussion: This pilot RCT will be the first to study the potential of WHO-developed scalable interventions aimed at reducing mental health problems within (Dutch) prisons. Results from this study could subsequently inform a potential full-powered RCT.

Trial registration: This trial is registered on ClinicalTrials.gov (number NCT05927987) on 13/06/2023.

Background: Research suggests that educational programs that impact well-being show the greatest promise for promoting behavioral change and providing incarcerated men and women with the skills necessary to reintegrate into communities successfully. The development of well-being is a key component of such educational programs, as it affords important protective factors in the face of stress and difficulty and improves individuals' chances of stable re-entry to their communities. The Urban Ministry Institute (TUMI) is a faith-based, seminary-level, higher-education program that enhances healthy thinking, prosocial behavior, and positive interpersonal relationships for incarcerated men and women in the United States.

Methods: We evaluated well-being among TUMI participants incarcerated in correctional facilities in Texas, Kansas, and among groups of formerly incarcerated TUMI graduates in California, Texas, and Kansas. We conducted focus groups with 109 men and women inside six prisons, and 157 people completed mixed methods surveys, for a total of 266 data points.

Results: Qualitative results fell into three primary themes related to well-being, namely healthy thinking patterns, prosocial behavior, and positive interpersonal relationships. Participants completed the Flourishing Scale, reporting agreement with all eight statements, with particularly strong agreement to statements related to healthy thinking patterns.

Conclusions: Findings provided support for the growing argument that faith-based correctional education promotes wellbeing, which is a key factor in improving behavior, reducing disciplinary infractions, and preparing incarcerated men and women for successful reintegration into their communities. Overall, this research demonstrates the potential value of providing educational opportunities like TUMI to incarcerated individuals.

Objectives: Recent studies have demonstrated that parental imprisonment (PI) is associated with cardiometabolic risk later in life. However, underlying risk factors for these associations have not previously been explored. Using a life course framework, the present study explores how early childhood emotional and behavioral dysregulation and PI may be associated with progressive cardiometabolic risk factors in adolescence and young adulthood among male and female respondents in an Australian birth cohort.

Methods: The study follows a subset of 7,223 live, singleton births from 1981 to 1984 in Brisbane, Australia where data was collected on parental imprisonment at ages 5 & 14 and behaviors from the Child Behavioral Checklist (CBCL) at age 5. Our sample examines 1,884 males and 1,758 females whose mothers completed prenatal, age 5, and age 14 interviews and respondents completed one or more interviews at a health clinic at ages 14, 21, and 30. Multivariate regression was used to examine cross-sectional results, while individual growth models examined longitudinal patterns.

Results: Dividing the analysis by sex, we examined how parental imprisonment was potentially mediated or moderated by CBCL subscale measures for aggression, social-attention-thought (SAT) disorders, internalizing, and depression. No associations were found among male respondents. Among female respondents, controlling for these behaviors, there was a significant association between parental imprisonment and higher systolic blood pressure at age 30, while all CBCL measures were found to moderate waist circumference at age 30 and BMI at ages 14, 21, and/or 30. Using individual growth curve modelling, we observed the increased CBCL aggression and SAT scores were increasingly associated with higher BMI as respondents aged in adulthood.

Conclusions: Using prospective cohort data, our results suggest that PI and emotional and behavioral dysregulation are associated with BMI, systolic blood pressure, and waist circumference in females, along with potentially increasing levels of cardiometabolic risk, as measured by increased BMI, from age 14 through age 30. The result is suggestive of the importance of examining early emotional/behavioral problems and PI as joint risk factors for developing cardiometabolic risk factors that may progress into cardiometabolic diseases at later stages in the life course.

Background: Sexual minority (SM) female adolescents involved in the legal system experience marginalization and health inequities. This study examined the differences in psychosocial functioning and risk behaviors among legally involved SM and heterosexual female adolescents to better understand their behavioral health needs. We hypothesized that SM females, as individuals at the intersection of two marginalized groups, would demonstrate greater psychiatric symptom severity and engagement in risk behaviors than their heterosexual counterparts.

Methods: Adolescents involved in the legal system (N = 423) enrolled in a prospective cohort study and completed baseline surveys assessing their demographics, SM status, psychiatric symptoms, substance use, and engagement in self-injurious, delinquent, and sexual risk behaviors. The responses of SM and heterosexual female adolescents (n = 193) were compared using bivariate and regression analyses.

Results: Participants were 12 to 18 years old (M = 14.49, SD = 1.55), ethnoracially diverse, and 38.3% identified as a SM. SM females, as compared to heterosexual females, reported more PTSD and emotional symptoms, difficulties with anger control and personal adjustment, and engagement in substance use, self-injurious, and sexual risk behaviors.

Conclusion: Legally involved SM female adolescents in this study had greater psychiatric, substance use, and sexual health treatment needs compared to their heterosexual peers. These findings highlight the need for enhanced understanding of how to effectively support SM female adolescents, including utilization of culturally sensitive and clinically informative screening practices that do not contribute to further discrimination within the legal system. Future work should aim to develop identity-responsive interventions tailored to this population.

Background: The Veterans Health Administration has made strides to improve access to medications for opioid use disorder overall. However, quality improvement methods to assess treatment gaps may not sufficiently detect differences in medication access by intersecting patient factors, which may have multiplicative rather than additive effects. This study aimed to determine whether race/ethnicity and legal involvement interact in receipt of medications for opioid use disorder among Veterans Health Administration patients.

Methods: Using national electronic health record data from Fiscal Years 2021-2022, we examined the receipt of medications for opioid use disorder among veterans diagnosed with opioid use disorder who received healthcare at Veterans Health Administration facilities (n = 65,883). We conducted a mixed effects multivariable logistic regression model to examine an interaction effect of race/ethnicity and legal involvement with receipt of any medications for opioid use disorder, both unadjusted and adjusted for patient and facility characteristics.

Results: In an adjusted logistic regression model, the interaction effect indicated that non-Hispanic Black veterans with legal involvement had the lowest odds of medications for opioid use disorder receipt compared to non-Hispanic White veterans without legal involvement (adjusted odds ratio = 0.67, 95% confidence interval = 0.59-0.77, p <.0001). Non-Hispanic American Indian/Alaska Native patients without legal involvement (adjusted odds ratio = 0.85, 95% confidence interval = 0.73-0.99, p =.04) also had lower odds of receipt of medications for opioid use disorder compared to non-Hispanic White patients without legal involvement. Non-Hispanic White veterans with legal involvement (adjusted odds ratio = 1.07, 95% confidence interval = 1.01-1.14, p =.03) had higher odds of receipt of medications for opioid use disorder compared to non-Hispanic White patients without legal involvement.

Conclusions: Veterans Health Administration quality improvement efforts should monitor interacting racial and legal status factors and understand and address patient, clinical, and regulatory barriers to medications for opioid use disorder among Black veterans with legal involvement.

Background: Violence has fluctuated in the United States in recent years. Additionally, policing practices have been challenged, especially in neighborhoods of color. Community Violence Intervention (CVI) programs have emerged as an effective policy to address violence through neighborhood-centered resources, trauma-informed care, and credible messengers, without full reliance on law enforcement officials. However, inconsistent funding challenges the feasibility and sustainability of these programs. In 2021 several states introduced policies to allocate Medicaid reimbursement for CVI services offering a promising solution to a more sustainable stream of funding.

Methods: This study uses rigorous qualitative analysis to evaluate the implementation of Medicaid reimbursement policies in California, Illinois, and Connecticut, applying the Exploration-Preparation-Implementation-Sustainment (EPIS) model. An analysis of secondary documentation and semi-structured interviews with key stakeholders from the first three states to implement the policy. Stakeholders were recruited from a variety of policy, medical, and non-profit sectors to provide their perspectives and expertise on implementation.

Results: Interviews with stakeholders from policy, medical, and non-profit sectors and a deep analysis of secondary documentation identifies key successes and barriers to effective implementation of Medicaid reimbursement policies across the United States. Acknowledging the barriers of implementation highlights where policy planning and development fails to be properly implemented on the ground. Findings emphasize the need for state-specific policy adaptation, collaboration amongst policymakers and practitioners, and sufficient training for on-the-ground CVI staff members.

Conclusions: Implementation of a Medicaid reimbursement policy for CVI programs could improve the efficacy and sustainability of such programs. However, states need to be aware of the challenges that may arise during the planning and implementation phases. The findings from this study reveal that policy makers, service providers and medical professionals need to be involved and collaborative throughout the planning and implementation process of the policy. States that are planning to implement these policies should assess whether they are ready to implement the policy to ensure that it is successful in the long term.

Background: Massachusetts passed legislation in 2018 to mandate provision of medications for opioid use disorder (MOUD) in select jails to address the high risk of opioid overdose after release. Since 2019, we have conducted a Type-1 hybrid effectiveness-implementation study of this program. We present findings on the perspectives and experiences of persons treated in these jails.

Methods: We conducted qualitative analyses of semi-structured interviews that were conducted in 2022 with 38 adults released to the community who had been treated with MOUD while living in one of eight Massachusetts jails. The Exploration, Preparation, Implementation, and Sustainment (EPIS) framework informed development of the interview guide and analysis of qualitative data. Deductive and inductive strategies were used for coding and analyses.

Results: Participants were 41.5 years old; predominantly male; 84.2% white, 23.7% Hispanic/Latino and 7.9% Black; and most continued taking MOUD. Thematic analysis focused on four code reports: Perception of Addiction/MOUD, Barriers/Facilitators, Impact of MOUD in Jails, and Stigma. Participants perceived that MOUD helped to prevent relapse. Prompt and consistent access to medication, and respectful treatment by healthcare and carceral staff were highlighted as facilitators. In contrast, some participants perceived that policy-centered rather than patient-centered treatment drove timing of medication initiation or response to medication changes. Insufficient staffing and the COVID-19 pandemic contributed to treatment delays. Overall, individuals incarcerated in jails that have expanded treatment eligibility to include earlier induction with MOUD generally felt more positive about their experience than individuals reporting delayed induction.

Conclusions: Participants valued the ability of jail based MOUD programs to help clients achieve recovery from OUD. Their perceptions highlight the intrinsic value of MOUD programs that promote and support wellbeing through a person-centered approach to treatment. Participants stressed that MOUD programs should be patient-centered and guided by patients' symptoms and needs.

Background: In response to the U.S. overdose crisis, many states have increased criminal penalties for drug possession, particularly fentanyl. This study sought to qualitatively explore diverse community perspectives on increasing criminal legal penalties in Colorado for fentanyl possession (House Bill 22-1326) and the broader role of the criminal legal system in addressing substance use and overdose prevention. We conducted 31 semi-structured interviews in 2023 with community leaders directly working with people who use drugs, individuals with lived experience with drug use and the criminal legal system, and law enforcement throughout Colorado. Interviewees were asked about the perceived impact of House Bill 22-1326 on their communities and agencies. After interviews were complete, we created templated summaries and matrix analyses to conduct rapid qualitative analysis, an action-oriented approach to qualitative data analysis.

Results: Respondents included peer support specialists (n = 7), policymakers (n = 6), community behavioral health/harm reduction providers (n = 6), criminal legal program staff (n = 8), and law enforcement (n = 4), with nine participants from rural counties. Analysis revealed that participants found increasing criminal penalties for fentanyl possession to be misguided: "And the felony [of HB-1326] is such a good example of a policy being led by feelings rather than evidence." This was in the context of participants' divergent views on police as conduits to treatment and punishment and perceiving jail as an (in)appropriate response for substance use disorder treatment.

Conclusions: All participants supported policy efforts to prevent fatal fentanyl overdoses, yet, most thought that increased use of police and incarceration as avenues to prevent overdose was misguided. This study highlights a diverse array of community perspectives that can inform policy decisions concerning criminal penalties for fentanyl possession and distribution and can inform policies that affect people who use drugs broadly.

Background: Roughly 50%-75% of youths who have had contact with the juvenile justice system have a mental-health disorder. In 2019, a northeastern state required probation departments to implement an evidence-based behavioral health (BH) screen. e-Connect is a digital clinical decisional support system designed to identify suicide thoughts and behaviors and related BH risk and triage youths based on BH need, then facilitate linkage to care.

Objective: To identify the resources and estimate the costs required to implement and sustain e-Connect from probation-department and policymaker perspectives.

Methods: Prospective micro-costing analysis conducted concurrently with a rigorous evaluation of e-Connect. Data were collected for 622 youths ages 10-18 via administrative records, study instruments, and semi-structured interviews. Resources/costs were categorized as "fixed", "time-dependent", or "variable". Mean annual costs (per-county and per-screen, by county) were calculated for two intervention phases, "implementation" and "sustainment". All costs are in 2019 USD.

Results: The policymaker-relevant, annualized, mean, per-county start-up and sustainment costs were $18,704 (SD = $14,320) and $13,374 (SD = $13,317), respectively. The per-screen sustainment cost was $115 (SD = $113) across counties, with variation attributed to a combination of a county's behavioral-health needs, and differences in the types of resources utilized as part of their post-screening clinical response.

Conclusion: The results of this analysis will inform the decisions of probation departments and their stakeholders, who are interested in implementing an evidence-based behavioral-health screen for youths on probation. Site-level figures will provide important details regarding the resources/costs associated with various implementation and management strategies. Cross-site, per-person averages will provide crucial inputs into budget impact models and cost-effectiveness analyses.

The aging population in United States (US) correctional facilities has grown dramatically over the last several decades. At present, roughly one in four adults incarcerated in US prisons are at least 50 years of age. Research over the last ten years has likewise expanded to catalog the impacts of incarceration on older adults, and the myriad ways incarceration is unique for this population. In this paper, we summarize the state of the literature at the intersection of incarceration, health, and aging. We begin by outlining the impacts of incarceration on a range of individual health outcomes for older adults. Next, we offer targeted policy implications to address the health consequences of incarceration for older adults. Finally, we conclude by offering a research agenda that emphasizes theory building, jail-based approaches, and expansion of what is known about older women, cognitive impairment, correctional staff perspectives, and interventions to enhance the health of older persons who are incarcerated.