Intervention for Firesetting Offenders: A Case Study

There is little research on treatment for firesetting, especially for those who were incarcerated for their offenses. Of the treatment programs that do exist, there are limitations to feasibly implementing these in correctional settings. We propose a short-term (eight-session) program, Intervention for Firesetting Offenses (INFO), based on techniques that have been empirically supported for this population, including psychoeducation, motivational interviewing, cognitive behavioral therapy-based strategies, and relapse prevention. We provide a description of INFO using the case study of Mr. A, a man who was incarcerated for an arson offense. Overall, INFO was feasibly and effectively implemented, as the individual improved his understanding of firesetting in general and his own motivations and risk factors for engaging in firesetting and developed a relapse prevention plan to avoid future offending behaviors.

Burnout among Professionals Working in Corrections: A Two Stage Review

Burnout is a state of emotional, physical, and mental exhaustion often caused by excessive and prolonged stress. Given the emotionally and often physically demanding nature of the work of correctional professionals, they are at substantial risk of suffering the adverse consequences of burnout. We systematically reviewed (Stage 1) the influence of burnout amongst forensic psychologists, psychiatrists, case workers, nurses, and correction officers. Interventions were then reviewed (Stage 2) at the individual and collective level to examine the effectiveness or efficacy of treatments for burnout among professionals working in corrections.

A Content Analysis of Prison Websites: Exploring Approaches to Rehabilitation in Latin America

Across much of Latin America, prison systems are characterized as having significantly high incarceration and overcrowding rates. In recent years, some of these systems have sought to address such problems by implementing rehabilitation and early release programs. However, the extent to which rehabilitation has been embraced and the nature of said efforts is not known. Using content analysis methods, this exploratory study examines the existence of language supporting rehabilitative practices and goals on official prison system websites across the region. While our findings suggest that prison systems have largely embraced rehabilitative goals, there is limited evidence to indicate that evidence-based practices are emphasized when it comes to assessment and correctional programs. As countries embrace rehabilitative efforts, it is important that they use empirically supported practices, as a perceived failure of the rehabilitative approach could shift the pendulum away from treatment and toward punishment. Implications for future research are discussed.

Differentiating Sexual From Other Violent Offence Types for Case Assessment, Planning, and Management

Core components of the Intake Assessment (IA) process in the Canadian federal corrections system were examined to determine whether a simplified algorithmic equation for individuals sentenced for sex crimes could be tailored and differentiated from other violent offence types. Two major offence type categories, namely sexual and other violent were constructed for 2,896 adult male first releases for 2016 to 2017 and 2017 to 2018. A restricted set of static risk indicators, dynamic need ratings, and other actuarial measures as well as whether or not there were any returns to federal custody were extracted for each case. A combined risk index yielded robust predictions of custodial return for sexual and other violent offence types with significant and robust AUCs of 0.77 and 0.71, respectively. Analyses showed that five-level risk groupings could be derived independently for the two offence type categorizations.

Conditional release and cannabis use: Concerns and challenges for community reintegration

This article, which serves as a perspective review, delves into the complexities of cannabis use among individuals preparing for or already on conditional release (CR). These complexities include an association between cannabis use and mental illness and dealing with the fact that the use of illicit substances, such as cannabis, is against CR rules, leading to potential revocation. A focus of this article is the deleterious effects cannabis and synthetic derivatives of cannabis can have for individuals on CR. The article concludes with six-specific recommendations for managing cannabis use in this population with a focus on careful and detailed risk assessments that considers the relationship between substance use and dangerousness, the role of protective factors, the need for a detailed conditional release plan, inpatient and community-based interventions aimed at increasing individual autonomy, and education on the dangers of cannabis use for both the treatment team and the insanity acquittee.

Substance use-related suicide after release from correctional, behavioral health, and healthcare facilities using national violent death reporting system data

INTRODUCTION

Suicide and substance use are prevalent problems among persons discharged from facilities. This study (1) articulated rates of substance-related suicide deaths among those discharged correctional, behavioral health, and healthcare facilities, and (2) identified factors associated with substance-related suicide deaths unique to, or generalizing across, facility discharge.

METHODS

We used data from the National Violent Death Reporting System. Suicide deaths (N = 105,968) were aggregated from 2003 to 2017. Chi-square and independent samples t-tests were used to examine associations between drug/alcohol-related deaths and each correlate. Logistic regression was employed to identify the most robust substance-related suicide death-related factors.

RESULTS

Suicide deaths were commonly marked as being substance-related: 69% from correctional institutions, 54% from behavioral health facilities, 45% from those not released from a facility, and 39% from healthcare facilities. Regression models indicated housing interruptions and interpersonal stressors increased odds of the suicide death being marked as substance-related across discharge categories. Each discharge category also had unique predictors, underscoring the need for tailored prevention.

CONCLUSIONS

Substance-related suicide deaths are particularly common among adults discharged from correctional and behavioral health facilities. Findings are discussed with respect to community-focused, discharge planning, and clinical care suicide prevention strategies.

A Comparison Between Rural and Urban Jail Proximities to Inpatient Mental Health Care in New York State

The authors created a model to examine the distance between jails and inpatient mental health care facilities in rural counties versus urban counties in New York State. Using U.S. census data, the top seven most rural counties and top seven most urban counties were selected for analysis. Results indicate that, overall, urban jails have closer access than rural jails to inpatient mental health care, with the furthest facilities for urban jails being 15.1 kilometers and the furthest for rural jails being 43.6 kilometers. The closest inpatient mental health care facility for urban jails was 174 meters, whereas the closest mental health care facility for rural jails was 0.02 kilometers. Average distance from inpatient mental health care was 4.3 kilometers for urban jails and 26 kilometers for rural jails. Policy implications are discussed.

Medical Assistance in Dying (MAiD) for Canadian Prisoners: A Case Series of Barriers to Care in Completed MAiD Deaths

Background: As of August 2020, 11 patients who were federally incarcerated in a Canadian prison requested medical assistance in dying (MAiD), and three received it. This case study seeks to understand the process of care as described by physicians involved in each of the cases that resulted in MAiD. Methods: During the summer of 2020, semistructured interviews were conducted with physicians involved in each known Correctional Service of Canada (CSC) MAiD case. Transcripts were summarized to illuminate details of the care process for each patient, highlighting barriers to patient-centered care. Results: Each case took place in a different province. One MAiD provision took place in a prison hospital, and two provisions took place after the incarcerated patients were transferred to external community hospitals. Case summaries highlight the physicians' efforts and challenges in assuring patient-centered care. Discussion: Physician experiences illuminate several barriers to care: CSC bureaucratic processes that forced longer wait times than typical for patients in the general public; challenges related to accessing release before MAiD application; knowledge of patient preference for location of death; concerns of voluntariness and confidentiality that are unique to CSC patients; and ethical considerations surrounding the presence of prison guards, police officers, and shackles at the time of assessment or provision. Reporting by the Office of the Correctional Investigator highlights additional challenges in these cases. Further inquiry is necessary to include the perspectives of prisoners and prison staff, and to consider how the evolution of new MAiD legislation will affect MAiD for prisoners.

Effect of Clozapine on Time Assigned to Restrictive Housing in a State Prison Population

This study examined the effect of clozapine on time assigned to restrictive housing (RH; i.e., solitary confinement), disciplinary infractions, and assaults on custody staff among patients treated within the North Carolina prison system. Records were reviewed for patients initiated on clozapine (n = 84) over a 3.5-year period. Fifty-nine patients completed at least three consecutive months of treatment and were included in data analysis. Assigned RH days and disciplinary infractions were assessed for the periods prior to and after treatment with clozapine. Patients accumulated 13,500 RH days pretreatment and 3,560 days postclozapine initiation. There was a significant reduction in RH days with clozapine treatment (P < .05). Patients with personality disorders (n = 36) had a significant decrease in RH days (P < .05), while those with psychotic disorders (n = 23) showed a decrease with borderline significance (P = .051). There were 253 disciplinary infractions pretreatment, including 27 assaults on custody staff, and 118 infractions posttreatment, including 7 assaults; the decrease in infractions was significant in the first three months of treatment (P < .05). The mean ± SD duration of treatment was 269 ± 102 days. Expanding clozapine use in state prisons should be a high priority, as these data are consistent with reports of clozapine's benefits in community settings.

Multiple scattering and resolution effects in small-angle neutron scattering experiments calculated and corrected by the software package MuScatt

This article deals with multiple scattering effects that are important for the method of small-angle neutron scattering (SANS). It considers three channels for the coherent elastic, the incoherent elastic and the incoherent inelastic scattering processes. The first channel contains the desired information on the experiment. Its multiple scattering effects can be desmeared, as shown in the later sections of the article. The other two channels display a nearly constant background as a function of the scattering angle. The incoherent elastic scattering is treated by the theory of Chandrasekhar, allowing for multiple scattering even at large scattering angles. The transfer to a single representative thermalized wavelength by the inelastic scattering - as a simplification - is assumed to happen by a single scattering event. Once the transition to this altered wavelength has happened, further incoherent multiple scattering is considered. The first part of the paper deals with the multiple scattering effects of light water. In the later part of the article, deconvolution algorithms for multiple scattering and instrumental resolution of the elastic coherent signal as implemented in the program MuScatt are described. All of these considerations are interesting for both reactor-based instruments with velocity selectors and time-of-flight SANS instruments and may improve the reliability of the data treatment.

Abjection and the weaponization of bodily excretions in forensic psychiatry settings: A poststructural reflection

Nurses working in forensic psychiatric settings face unique challenges in practice, where they take on a dual role of custody and caring. Patient resistance is widespread within these restrictive settings and can take many forms. Perhaps the most disturbing form of resistance entails a patient's weaponization of their bodily fluids, with nurses as their target. The tendency in assigning motive for this act is to relegate to the psychopathology of the patient. This paper will adopt a poststructuralist perspective to reexamine this phenomenon as an act of resistance through the lens of Kristeva's concept of abjection. Patients confined in these settings have little sense of control, and in resistance may resort to the only thing available: their bodily fluids. By weaponizing the abject, patients actively violate and permeate the physical and psychological boundaries of nurses-the very boundaries considered crucial to safe and professional forensic psychiatric nursing practice. By recognizing this phenomenon as an act of resistance to confinement and loss of control, nurses may reorient their approach to care in forensic psychiatric settings.

Pharmacological interventions for alcohol misuse in correctional settings: A systematic review

BACKGROUND

The prevalence of alcohol use disorder (AUD) is estimated to be 10 times higher amongst individuals in the criminal justice system than the general population. Alcohol use is also one of the strongest modifiable risk factors for recidivism. One intervention that has been shown to be effective in reducing alcohol consumption in the general population is medication-assisted treatment (MAT), and this systematic review synthesized the existing evidence on MAT for AUD in correctional settings.

METHODS

Empirical, peer-reviewed studies on approved medications for AUD in correctional populations were searched in major databases. One hundred sixty-two articles were initially screened and 14 eligible articles were included in the final review. Four articles examined disulfiram, and 10 articles examined naltrexone.

RESULTS

The studies on disulfiram were considerably older than those on naltrexone, predating contemporary scientific standards. Disulfiram in combination with substantial contingencies in a supervised setting significantly reduced alcohol-related measures of consumption and recidivism and had acceptable safety and tolerability. All naltrexone studies showed significant reductions in alcohol-related measures, but effects on recidivism were mixed. The naltrexone studies indicated that it was highly acceptable and well tolerated. In addition, offenders receiving naltrexone had significantly greater medication adherence, treatment attendance, and treatment duration than with placebo.

CONCLUSIONS

A small number of studies on pharmacological interventions for AUD in the correctional population suggest that MAT is effective in reducing alcohol consumption, although results on recidivism are mixed. On balance, the evidence was more supportive of naltrexone in reducing alcohol-related outcomes than disulfiram and it may also be a more feasible intervention in correctional settings. Further research on MAT to address AUD in correctional populations with larger sample sizes, longer duration, and in combination with behavioral interventions is warranted.

A Pilot TB Screening Model in a U.S. Prison Population Using Tuberculin Skin Test and Interferon Gamma Release Assay Based on Country of Origin

The objective of this study was to compare tuberculosis (TB) screening results before and after implementation of a stratified testing strategy screening pilot study, incorporating interferon gamma release assay (IGRA) and tuberculin skin test (TST), based on country of origin. In 2015, the Washington State Department of Corrections began screening people born outside of the United States for TB with IGRA, while U.S.-born people continued screening by TST. Of 405 (75%) foreign-born men screened with IGRA, 403 had valid test results and IGRA screening positivity was 10.4% (N = 42). In contrast, among 5,940 primarily U.S-born men screened with TST, 24 (0.4%) were positive. Overall positivity was 1.05%, similar to TST-only positivity in 2013 (1.05%) and 2014 (0.85%). Incorporating IGRA screening among foreign-born persons was feasible in this state prison system.

Who Are the Compliant Correctional Clients? New Evidence on Protective Factors among Federal Supervised Releases

Protective factors facilitate success on community supervision, but relatively little is known about correctional clients who are highly compliant particularly in the federal system. Drawing on a near population of federal clients on supervised release in the Midwestern United States, the current study examined variables associated with compliant supervision status. One day on supervision contributed to a 1% reduction in the logged odds of supervision compliance. Clients with no drug history had 793% increased odds, clients with sustained remission had 620% increased odds, and clients with early remission had 458% increased odds of compliant supervision status relative to clients actively using drugs. Among the federal Post Conviction Risk Assessment (PCRA) indices, only PCRA Criminal History was significant as clients with less extensive criminal history were more likely to be compliant supervision clients. A one-unit change in PCRA Criminal History status was associated with 25% reduced odds of supervision compliance. Total conditions were inversely associated with compliant supervision status with each additional condition associated with a 19% reduced likelihood of compliant supervision status. None of the demographic variables was significantly associated with compliant supervision status. Implications of the findings for the protective factor paradigm in corrections are discussed.

Interpersonal Violence and Institutional Misconduct in the Los Angeles County Jail System: A Mixed Method Investigation

This study involved a mixed method evaluation of interpersonal violence and institutional misconduct in the Los Angeles county jail system. Interviews with 52 correctional staff uncovered a widely shared belief that AB 109, Prop 47, and the Rosas decision had all contributed to an increase in violence and misconduct in the jail. Analysis of administrative records indicated there was a rise in the monthly rates of these adverse outcomes from 2010 to 2017. Intervention ARIMA models, however, revealed evidence of a statistically significant increase following only the passage of Prop 47. An examination of inmate characteristics across the 8-year observation period confirmed staff suspicions that jail incarcerates with more extensive criminal histories were being confined following the passage of these policies. If jails are to be responsible for confining higher risk inmates, provisions should also be made to increase the availability of evidence-based rehabilitative programming and other treatment services that can help combat the occurrence of these adverse outcomes.

Enhancing Mental Health Treatment for Borderline Personality Disorder in Corrections

Improving mental health among inmates has been a long-term challenge for correctional systems. Although borderline personality disorder (BPD) has garnered limited attention in the literature, evidence suggests it is highly prevalent in corrections. It is important to provide comprehensive treatment for this condition, given its high prevalence and significant personal, societal, and economic burden. This article discusses two approaches aimed at enhancing mental health treatment for BPD in corrections. The first focuses on implementing evidence-based psychotherapy that is customized to the correctional setting. The other approach is expanding telemental health to overcome clinician shortages and maintain high-quality care.

Mischief, Mayhem, and Remediation

Institutional rules are necessary to preserve safety and security in correctional systems. An assessment of relevant mental health problems is a key element of a fair disciplinary process. Though these hearings are administrative in nature, we recommend that mental health evaluations related to disciplinary matters be completed by qualified and well-trained professionals using consistent standards. There are important opportunities to interrupt an untreated mental illness by identifying mental health problems during such evaluations and making appropriate referrals for treatment. We propose the use of intrafacility diversionary programs for drug offenses and other misconduct.

Trauma-Informed Care: The Importance of Understanding the Incarcerated Women

Numerous studies and research substantiate strong correlations between adverse childhood experience (ACE) scores and corrections. This study assessed the significance of trauma-informed care (TIC) in the recidivism rates of incarcerated women. A retrospective longitudinal survey was conducted. ACE scores were evaluated and documented through a self-reported survey. Seven years of Correctional Offender Management Profiling for Alternative Sanctions registry documentation was assessed. Descriptive statistics were utilized to define patients and evaluate patterns of recidivism after implementation of trauma-informed approaches to care. There is strong evidence associating lower recidivism rates for those who participate in TIC and trauma programs than for those who do not. This evidence supports further evaluation with a serious potential impact of reduction in recidivism and improved trajectories for incarcerated women and their families.

Compassion in Corrections: The Struggle Between Security and Health Care

Many incarcerated individuals have chronic health conditions and mental health issues that have not been addressed by health care providers in years, if not decades. Patients in correctional settings are isolated from society and have reduced access to health care. Prison is a lonely scary place. How then do nurses impact the lives of these patients? It can be challenging given safety concerns, resource issues, and the bias of not only the nurse but also the security staff with whom they are working. Nurses have a responsibility to their patients to beneficence, justice, nonmaleficence, and autonomy. Compassion in corrections, though, is often viewed as naivete or weakness. Should these qualities be left out of corrections? By identifying one's own bias and asserting firm consistent practices, correctional nurses can set an example of unbiased care. The standards of care are the minimum required, but are they enough?

Impact of a Total Worker Health® Mentoring Program in a Correctional Workforce

(1) Background: Correctional Officers show signs of adverse health early in their careers. We evaluated the impact of a one-year peer health mentoring program for new officers based on a Total Worker Health® approach; (2) Methods: Cadets (n = 269) were randomly assigned to a mentored or control group. Cadets in this mixed methods design completed physical assessments, and surveys at three time points to assess demographics, health, mentoring, and workplace variables. Physical testing included several health markers. Surveys and physical data were analyzed as repeated measures. Regression analyses were used to analyze the relationship between mentoring characteristics and outcomes. A semi-structured interview of mentors was analyzed qualitatively. (3) Results: Higher mentoring frequency was associated with lower burnout. Health behaviors and outcomes declined over time in all groups, but mentees displayed slower decline for body mass index (BMI) and hypertension compared to controls. (4) Conclusions: A continuous peer health mentoring program seemed protective to new officers in reducing burnout and also declines in BMI and hypertension. Short-term physical health markers in younger officers may not be an index of psycho-social effects. A participatory design approach is recommended for a long-term health mentoring program to be both effective and sustainable.

Implementing a Culture of Health Among Probationers

Justice-involved individuals struggle with a multitude of health issues, and addressing the needs of these individuals requires the efforts of multiple agencies working across traditionally siloed systems. This study provides evidence on the implementation of a one-stop health services delivery model, Culture of Health, piloted in an urban probation office. This model uses a change team approach to focus the efforts of multiple agencies toward improving the alignment, collaboration, and synergy of health and other social service delivery to this underserved population. This article reports on the development and application issues involved in instituting such a novel design. The study demonstrates that the health culture within probation, buy-in from probation officers, and dwindling support from change team members all posed noteworthy issues for program implementation.

Leadership in Correctional Nursing: The First Step

Correctional nurses fulfill many roles in the provision of health care to incarcerated individuals. The role most readily visible is health care provider, but today's nurses are also expected to fill a variety of different leadership roles. Leadership is recognized as a fundamental characteristic of nursing by the nursing organizations that set professional standards. Possessing leadership skills is thus vital to the professional correctional nurse. The first step in developing leadership skills requires introspection and contemplation. Today's nursing leaders must understand and express their core values and beliefs if they want to establish and enhance their credibility. This article explores personal inspiration and motivation and guides nurses through the process of articulating their beliefs and values to their constituents in the form of a Personal Professional Philosophy Statement.

Patterns and Predictors of Reincarceration among Prisoners with Serious Mental Illness: A Cohort Study: Modèles et prédicteurs de réincarcération chez les prisonniers souffrant de maladie mentale grave : Une étude de cohorte

BACKGROUND

A small proportion of people who have serious mental illness and rapid and frequent incarcerations account for a disproportionate amount of overall service use and cost. It is important to describe such individuals, so that services can respond more effectively.

METHODS

We investigated a cohort of 4,704 incarcerated men and women who were discharged from a correctional mental health service and followed for a median of 535 days. We investigated social, clinical, demographic, and offense characteristics as predictors of return to the service using Cox survival analyses. Secondly, we characterized individuals as high-frequency service users as those who had 3 or more incarcerations during a 1-year period and investigated their characteristics.

RESULTS

We found that a higher rate of return to custody was associated with schizophrenia spectrum/bipolar affective disorder (BPAD), personality disorder traits, crack cocaine and methamphetamine use, and unstable housing. Charges of theft/robbery and breach of probation were also positively associated, and sex assault was negatively associated with return to custody. Within a 1-year time period, we found 7.2% of individuals were high-frequency service users, which accounted for 19.5% of all reincarcerations.

CONCLUSION

Identification of the characteristics of those with mental illness in custody, especially those who have high-frequency returns to custody, may provide opportunity to target resources more effectively. The primary targets of intervention would be to treat those with schizophrenia/BPAD and substance use problems, particularly those using stimulants, and addressing homelessness. This could reduce the problem of repeated criminalization of the mentally ill and reduce the overall incarceration rate.

Release or Denial: Evaluating the Roles of Emotion and Risk in Parole Decisions

Parole boards often incorporate numerous factors when making release decisions. These factors are typically related to the inmates' case files. However, in some instances, parole boards' decisions are influenced by factors outside of the case files, sometimes referred to as extra-legal factors. According to the emotion as social information model, emotion can communicate specific messages to others, and in this case, parole board members might unknowingly incorporate their own emotions and inmates' emotional displays into their decisions. The current study examines the role of parole board member and inmate emotional expressions as predictors of parole release decisions. Parole hearings were coded for emotion, parole board and inmate gender, supporter presence, and risk scores. Overall, risk scores and parole board members' emotions predicted release decisions. Higher risk scores were associated with a lower likelihood of release, and inmates' negative emotion was related to a lower likelihood of release. Implications are discussed.

Why Are Workplace Social Support Programs Not Improving the Mental Health of Canadian Correctional Officers? An Examination of the Theoretical Concepts Underpinning Support

In Canada, public safety personnel, including correctional officers, experience high rates of mental health problems. Correctional officers' occupational stress has been characterized as insidious and chronic due to multiple and unpredictable occupational risk factors such as violence, unsupportive colleagues and management, poor prison conditions, and shift work. Given the increased risk of adverse mental health outcomes associated with operational stressors, organizational programs have been developed to provide correctional officers with support to promote mental well-being and to provide mental health interventions that incorporate recovery and reduction in relapse risk. This paper uses two theories, the Job Demand Control Support (JDCS) Model and Social Ecological Model (SEM), to explore why workplace social support programs may not been successful in terms of uptake or effectiveness among correctional officers in Canada. We suggest that structural policy changes implemented in the past 15 years have had unintentional impacts on working conditions that increase correctional officer workload and decrease tangible resources to deal with an increasingly complex prison population. Notably, we believe interpersonal support programs may only have limited success if implemented without addressing the multilevel factors creating conditions of job strain.