Health and Justice最新文献

Introduction: Expanding access to medication for opioid use disorder (MOUD) to people involved in the carceral system is a priority for the New Hampshire Department of Corrections (NHDOC), where more than 40% of residents have an opioid use disorder (OUD). NHDOC participated in the multi-site Justice Community Opioid Innovation Network (JCOIN) clinical trial, "Long-acting buprenorphine vs. naltrexone opioid treatments in criminal justice system-involved adults (EXIT-CJS)". We examine the contributing factors to the expansion of the NHDOC MOUD program from 2021 to 2023, including participation in EXIT-CJS, which occurred from 2019 to 2024.

Methods: Data on quarterly MOUD prescribing and EXIT-CJS enrollments were abstracted from the NHDOC medical records from July 1, 2021- December 31, 2023 as part of a quality improvement initiative. To examine factors influencing expansion of the program, conversations were conducted with NHDOC leadership team and clinical staff.

Results: From 2021 to 2023, the quarterly number of patients treated with MOUD at the NHDOC increased by more than 400% from a total of 165 patients in July-September 2021, to 685 patients in October-December 2023. At the policy level, elimination of the federal DATA-Waiver (X-Waiver) Program allowed additional providers to prescribe MOUD. At the organizational level, support from NHDOC leadership, including Medical and Forensics and the Commissioner's Office, encouraged broader engagement in MOUD from providers, multidisciplinary staff, and security. This work was augmented through receipt of State Opioid Response (SOR) dollars with a requirement to continue to advance education for NHDOC staff on the efficacy of MOUD. Resulting discussions between medical providers, experts on addiction treatment, staff and residents supported a culture change in attitudes about MOUD. During this same time window, the NHDOC made significant adjustments in the distribution of MOUD by adjusting the nursing administration process thus reducing the stigma associated with being a patient on MOUD and treating MOUD medication administration like all other medical conditions.

Discussion: Policy-related, organizational, and individual factors contributed to the expansion of the MOUD program at the NHDOC. EXIT-CJS recruitment occurred synergistically with the expansion of the MOUD program. As NHDOC was engaged as a site in EXIT-CJS, study recruitment increased awareness of extended-release treatment options among residents and staff.

Background: This qualitative study investigated experiences and understandings of health literacy for those released from prison in later life. The global rise in older incarcerated individuals-defined as those aged 50 and above-poses significant public health and health equity challenges. With up to one in four prisoners being categorized as "older," their complex health needs often exceed those of younger inmates and the general community. An important but under-investigated challenge for this older population is navigating health care systems and self-management of health after release. Research evidence, albeit limited, has consistently identified health literacy deficits in this this population, complicating their health outcomes and reintegration more generally. This study fills a gap in the experience of health literacy for older people leaving prison, thus contributing to conceptual understandings and guiding targeted intervention development for this marginalised population.

Results: Fifteen people with lived experience of release from prison in older age (mean age = 57) and thirteen staff or stakeholders with relevant professional experience from Australia participated in workshops and interviews exploring health literacy during the post-release period. An abductive thematic analysis was applied to the data, guided by the concept of health literacy and organisational health literacy responsiveness. The analysis produced two global themes ("Change" and "Equipped and Enabled") and seven subthemes ("A demanding time of change", "Braving a new world", "Leaving prison care", "I can only do what I can", "Help me help myself", "Others are key", "Everybody's problem, nobody's job"). Together, these themes indicated these individuals are the subject of complex and overlapping life circumstances, with limited resources and support currently available for health literacy both during and after release.

Conclusion: This population are mostly passive health care and information 'receivers' as a result of their imprisonment, who must be equipped and enabled to become more active health literacy 'doers'. This can be achieved through interventions that prepare the person better for life in community, and improve positive self-concept. Health and custodial organisations have an important role to play, with opportunities for improvement apparent across areas such as communication, focused health literacy policies, and collaboration with community partners.

Background: This study uses the Practical, Robust, Implementation, and Sustainability Model (PRISM) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to describe how features of jail contexts are associated with the number of people linked to medication for opioid use disorder (MOUD) and sustainment of jail linkage programs implemented in Wave 1 of the HEALing Communities Study in Kentucky (HCS-KY) from 2021 to 22. The HCS-KY is part of a parallel-group, cluster-randomized wait-list controlled trial examining the effects of supporting wide-scale implementation of evidence-based practices to reduce opioid overdose deaths. One strategy involved implementation of MOUD linkage programs within five Kentucky county jails. Minutes from program planning and maintenance meetings led by HCS-KY implementation facilitators with linkage staff/supervisors and jail liaisons/partners (average of five participants/meeting) were coded following PRISM-RE-AIM using template analysis to understand variations in participation across sites as well as barriers to and facilitators of MOUD linkage implementation.

Results: Across the five jails, 277 participants met with linkage staff during and/or post-incarceration for 1,119 visits conducted in-person or via phone/video conference. Twenty-six participants linked to community-based MOUD treatment during the implementation period. Participation differed across sites based on jail and linkage staff utilization of implementation support strategies but did not affect program sustainment, which all jails pursued in some form. Qualitative analysis yielded four overarching themes characterizing jail linkage program implementation. First, program integration into jail infrastructure entailed navigation of jail facilities and technologies as well as legal factors surrounding linkage staff backgrounds and information-sharing. Second, adapting the intervention to site-specific needs required providing training and implementation support to jail and linkage staff tailored to each jail context. Third, facilitating inter-organizational and cross-system coordination was related to collaboration successes and challenges among the HCS-KY team, linkage staff, the courts, and other provider partners. Finally, staffing and legal factors influenced sustainment.

Conclusions: Only ~ 10% of participants linked to community-based MOUD despite intensive implementation support, yet jails highly valued the program and planned for sustainment. Given the complexities in postponing treatment initiation until reentry, we call for simultaneous efforts to integrate MOUD screening and treatment into jail booking processes.

Background: People released from prison have elevated rates of physical and psychiatric morbidity, and emergency department (ED) presentation when compared with the general population. However, little is known about the specific health concerns that are associated with these high rates of ED presentation. The aims of this study were to (a) ascertain the prevalence of multimorbidity (physical multimorbidity and concurrent psychiatric morbidity) in a sample of adults prior to release from prison, and (b) examine the association between physical multimorbidity, psychiatric morbidity, and ED presentations in this sample following release from prison.

Methods: We prospectively linked pre-release survey data collected between 1 August 2008 and 31 July 2010 from a representative cohort of 1325 sentenced adults in Queensland, Australia, to person-level ED, correctional, and death records. We assessed the multimorbidity of participants using the Cumulative Illness Rating Scale. The association between multimorbidity and rate of ED presentations was assessed by fitting a multivariable Andersen-Gill model to identify sociodemographic and criminal justice covariates. A sensitivity analysis was also conducted in which psychiatric morbidity was disaggregated into a 4-level dual diagnosis variable (none, mental illness only, substance use disorder only, dual diagnosis) and was fit separately from the physical multimorbidity measure to ascertain the degree to which these factors predicted ED presentation rates.

Results: 502 (48.0%) participants had multimorbidity, 265 (25.3%) had physical multimorbidity, and 608 (58.2%) had psychiatric morbidity. After adjustment for model covariates including dual diagnosis status, there was no statistically significant association between physical multimorbidity and ED presentation rate. However, after adjusting for model covariates including physical multimorbidity, participants with a diagnosis of either mental illness (aHR: 1.48; 95%CI: 1.08-2.03) or both mental illness and substance use disorder (aHR: 1.78; 95%CI: 1.33-2.37) had a higher rate of ED presentation than their counterparts without these diagnoses.

Conclusion: The presence of psychiatric morbidity is associated with an increased rate of ED presentation. Targeted interventions for adults released from prison with psychiatric morbidity are urgently needed.

Background: Recovery courts offer an empirically supported alternative to incarceration for legally involved individuals struggling with addiction. While studies suggest that graduation from recovery courts leads to a lower likelihood of recidivism as compared to incarceration, attrition rates among recovery court participants are high. Relatively little is known about how court participants' social and family interactions affect progression through recovery court programs - information that could facilitate development of interventions to decrease court program attrition.

Methods: We used in-depth, semi-structured qualitative interviews with recovery court participants (N = 68) across nine recovery courts in one northeastern state to explore the role of social relationships on recovery court program progress.

Results: We found the following relationships can serve as barriers or facilitators through the recovery court program: relationship with one's self, minor children, other family, twelve-step peer support group members, court program peers, sober living home residents, and court staff. Participants described how recovery courts favored increased focus on one's self, which was not practical for those with family roles, and study participants felt recovery courts hindered relationships with minor children. Although other family relationships could be motivational, participants also faced misunderstanding and stigma from family members. Furthermore, overreliance on family members and friends for logistical needs (e.g., housing, transportation) could stress fragile relationships and lead to missed court requirements. Court programming facilitated supportive relationships with peers in recovery through required twelve-step peer support group involvement and interaction with court peers. However, ongoing substance use among these peer groups could be distressing for participants, especially in residential facilities. Recovery court staff were further sources of new relationships that were validating of participant progress.

Conclusion: Our findings indicate that the impact of social relationships on recovery court participants is complex and could influence court program progress. We suggest that recovery courts serving legally involved populations consider borrowing approaches from the family treatment court model to strengthen pre-existing relationships and support navigation of parenting roles. Connection to wrap-around services could further alleviate stress on family dynamics. Additional incorporation of previous program graduates or those with substance use histories into recovery court programming could also be explored.

Psychological interventions are used as part of tertiary countering violent extremism (CVE) efforts throughout the world, but it remains unclear the type of psychological treatments commonly used as part of such interventions. This study combines a scoping literature review with interviews to identify and describe the type of psychological treatments used, as well as their structure, and implementation. The scoping review identified 34 tertiary prevention programs that include a psychological intervention spanning 22 countries. Additionally, 18 interviews with mental health providers and other practitioners directly involved in delivering tertiary prevention programs allowed us to complement the results of the literature review.

Background: There is growing recognition of digital technology's role in supporting desistance and improving the well-being and social inclusion of people in the criminal legal system (CLS). However, it remains significantly under-researched within England and Wales despite its implications for prison and probation policy and practice. This article provides empirical insights into the access to and use of digital technology and the digital competency of 41 people with offending histories in Wales, UK. The study utilises and supports Reisdorf and Rikard's (American Behavioural Scientist 62:1273-1290, 2018) digital rehabilitation model, which highlights the interconnectedness of the digital and social world and the need for CLS support to integrate digital competency skills and access to digital technology to help people desist from crime.

Results: The study revealed that people experience varying levels of digital exclusion, from not owning any digital hardware (smartphones, laptops, computers, and tablets) to being unable to afford data for their devices and lacking the digital competency to use digital technology effectively. We highlight the implications for people accessing support that can facilitate desistance and the need for training to improve digital skills.

Conclusion: Our findings further support Reisdorf and Rikard's (American Behavioural Scientist 62:1273-1290, 2018) digital rehabilitation model. We argue that online and offline spaces are intertwined, and understanding and addressing the digital needs of people in the CLS is essential to prevent further marginalisation and support desistance and other positive outcomes.

Background: Eliminating infectious diseases epidemics requires resources for testing, prevention, and treatment in jails. The 2022 Centers for Diseases Control and Prevention guidelines recommend offering hepatitis C virus (HCV), HIV, and STI testing at jail intake. Currently, the impact of offering testing at intake in jails has only been analyzed in the context of multi-modal strategies to increase testing. There is a lack of real-world data about the impact of offering testing at jail intake as a strategy to increase testing. In May 2022, Plymouth County Correctional Facility in Massachusetts added questions to their intake form offering HIV, HCV, syphilis, gonorrhea, and chlamydia testing. The goal of this project was to assess frequency of testing before and after the addition of infectious diseases testing questions to the intake form.

Case presentation: Data about infectious diseases testing completion per month were compared between February-April 2022 and May 2022-June 2023. The transition from rapid to venipuncture HIV testing was also compared between September 2021-June 2023. Data was assessed in monthly intervals. The median number of urine tests decreased from 39 to 28, and the median number of blood tests decreased from 21 to 15 after testing was offered during intake.

Conclusion: There were no significant trends in the run chart after the intervention. Although offering testing at intake is one important part of healthcare in jails, intake testing should be supported with other systems including access to phlebotomy, facilitated movement from the housing areas to the medical unit, and stigma reduction tools.

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.