Associations Among Childhood Trauma, Adolescent Problem Behaviors, and Adverse Adult Outcomes in Substance-Abusing Women Offenders

Kaum Geschlechtsunterschiede bei Opioidkonsumierenden in Haft

Hintergrund

Ein hoher Anteil inhaftierter Frauen weist eine Opioidabhängigkeit auf. Hinsichtlich der Frage, ob sich Frauen und Männer in ihrem Opioidkonsummuster unterscheiden, und ob sich empirische Belege für einen Telescoping-Effekt (späterer Einstieg in den Drogenkonsum bei beschleunigtem Verlauf der Abhängigkeit) bei den Frauen finden lassen, ist die Forschungslage uneindeutig. Dabei mangelt es an Studien zu möglichen Geschlechtsunterschieden, insbesondere im Strafvollzug.

Zielsetzung

In einer Stichprobe von n = 247 opioidabhängigen Gefangenen im bayerischen Strafvollzug wurden die weiblichen (n = 31) mit den männlichen (n = 216) Studienteilnehmenden hinsichtlich Alter, Drogenkonsum, Substitutionsbehandlung, psychischer Vorbelastung, Bildung und wirtschaftlicher Situation verglichen.

Methode

Die Daten wurden im Rahmen einer Erstbefragung der Studie „Haft bei Opioidabhängigkeit – eine Evaluationsstudie“ erhoben.

Ergebnisse

Im Drogenkonsum zeigten sich keine Unterschiede zwischen den beiden Geschlechtergruppen, es konnten folglich keine Hinweise auf einen Telescoping-Effekt bei opioidabhängigen weiblichen Gefangenen gefunden werden. Weiterhin fanden sich keine Unterschiede zwischen Frauen und Männern bezüglich der Substitutionsbehandlung, der Bildung und der wirtschaftlichen Situation. Frauen gaben häufiger an, vor der Haft an Depressionen gelitten zu haben und Opfer von sexuellem Missbrauch gewesen zu sein.

Schlussfolgerungen

Es zeigten sich Belege für eine stärkere psychische Vorbelastung bei den weiblichen im Vergleich zu den männlichen Inhaftierten mit Opioidabhängigkeit, darüber hinaus jedoch auffallend wenige Unterschiede. Bei der untersuchten Stichprobe handelt es sich um eine Gruppe, bei der möglicherweise eine besonders schwere Verlaufsform der Opioidabhängigkeit vorliegt, die etwaige geschlechtsspezifische Unterschiede in den Hintergrund treten lässt.

The effectiveness of psychosocial interventions at reducing the frequency of alcohol and drug use in parents: findings of a Cochrane Review and meta-analyses

BACKGROUND AND AIM

Parental substance use is a major public health and safeguarding concern. There have been a number of trials examining interventions targeting this risk factor. We aimed to estimate the effectiveness of psychosocial interventions at reducing parental substance use.

DESIGN

We used systematic methods to identify trials; pooling data using a random-effects model. Moderator analyses examined influence of parent gender, presence of child in treatment and intervention type.

SETTING

No restrictions on setting.

PARTICIPANTS

Substance using parents of children below the age of 21 years.

INTERVENTIONS

Psychosocial interventions including those that targeted drug and alcohol use only, and drug and alcohol use in combination with associated issues.

MEASUREMENTS

Frequency of alcohol use and frequency of drug use.

FINDINGS

We included eight unique studies with a total of 703 participants. Psychosocial interventions were more effective at reducing the frequency of parental alcohol use than comparison conditions at 6-month [standardized mean difference (SMD) = - 0.32, 95% confidence interval (CI) = -0.51 to -0.13, P = 0.001] and 12-month follow-up (SMD = -0.25, 95% CI = -0.47 to -0.03, P = 0.02) and frequency of parental drug use at 12 months only (SMD = -0.21, 95% CI = -0.41 to -0.01, P = 0.04). Integrated interventions which combined both parenting and substance use targeted components were effective at reducing the frequency of alcohol use (6 months: SMD = -0.56, 95% CI = -0.96 to -0.016, P = 0.006; 12 months: SMD = -0.42, 95% CI = -0.82 to -0.03, P = 0.04) and drug use (6 months: SMD = -0.39, 95% CI = -0.75 to -0.03, P = 0.04; 12 months: SMD = -0.43, 95% CI = -0.80 to -0.07, P = 0.02). Interventions targeting only substance use or parenting skills were not effective at reducing frequency of alcohol or drug use at either time-point.

CONCLUSION

Psychosocial interventions should target both parenting and substance use in an integrated intervention.

An Experimental Study of a Peer-Facilitated Violence Prevention Program for Women in Prison

The literature has shown a strong correlation between victimization and violence. As the majority of treatment programs for violence and the associated research have been focused on men, it is vital that services are also oriented to the needs of women who perpetrate violence. Beyond Violence (BV) was developed to fill the gap in violence prevention programming for justice-involved women with histories of violence victimization and perpetration. This randomized controlled trial reports the results of a peer-facilitated model of the BV program implemented in a women's prison. Women volunteered for the intervention and the study. Participants were randomized to either the 20-session BV condition or to a waitlist control (WC) condition. All 145 participants were asked to complete a preintervention (Time 1) and postintervention (Time 2) survey that included validated measures to assess for depression, anxiety, PTSD, anger/aggression, and emotional dysregulation. Preliminary analyses of the background characteristics and preintervention outcome scores showed no significant differences between the groups at Time 1, indicating that randomization was successful. Separate ANCOVAs were run for 13 outcomes measured using the pretest scores from study participants as the covariate and group assignment as the independent variable. Hypotheses were predominantly supported, and findings showed that the BV participants had significant reductions in the majority of the outcome measures at the postintervention assessment when compared to the WC participants. Future research should continue to explore the advantages of peer-facilitated program models and should incorporate postrelease outcomes to assess change over time.

Sexual Trauma Informed Understanding of Longitudinal Depression among Repeat Juvenile Offenders

Childhood sexual assault (CSA) victimization and depression are global public health concerns that disproportionately affect youths involved in the juvenile justice system. Little research has examined the influence of CSA on the stability of depressive symptoms among repeat juvenile offenders. The present study tested a gendered model of the association between lifetime CSA victimization and depression for three time points: baseline juvenile assessment entry; second reentry; and third reentry. Further, covariate analyses were conducted to explore the impact of socio-demographics on CSA victimization and depression. Results indicate that CSA victimization was associated directly with baseline depression and indirectly with depression at second reentry for both male and female justice-involved youths. For white, male youth, there were significantly higher rates of depression over time, than other males. However, age, African American or Hispanic race/ethnicity, living situation, and urbanity were not significantly associated with CSA victimization at baseline or depression over time. These findings underscore the need for juvenile justice services that address exposure to childhood trauma and mental illness more effectively.

Individual differences in the development of youth externalizing problems predict a broad range of adult psychosocial outcomes

This study examined how youth aggressive and delinquent externalizing problem behaviors across childhood and adolescence are connected to consequential psychosocial life outcomes in adulthood. Using data from a longitudinal, high-risk sample (N = 1069) that assessed children and their parents regularly from early childhood (ages 3-5) through adulthood, multilevel growth factors of externalizing behaviors were used to predict adult outcomes (age 24-31), providing a sense of how externalizing problems across development were related to these outcomes via maternal, paternal, teacher, and child report. Findings indicated strong support for the lasting connections between youth externalizing problems with later educational attainment and legal difficulties, spanning informants and enduring beyond other meaningful contributors (i.e., child sex, cognitive ability, parental income and education, parental mental health and relationship quality). Some support was also found, although less consistently, linking externalizing problems and later alcohol use as well as romantic relationship quality. Delinquent/rule-breaking behaviors were often stronger predictors of later outcomes than aggressive behaviors. Taken together, these results indicate the importance of the role youth externalizing behaviors have in adult psychosocial functioning one to two decades later.

Justice for Incarcerated Moms Act of 2021: Reflections and recommendations

In the last five decades, the number of women behind bars in the United States has risen exponentially. It is now estimated that there are nearly 58,000 admissions of pregnant people—disproportionately women of color—to jails and prisons each year. Recognizing the urgency and consequences of mass incarceration on pregnant people, their families, and communities, House Resolution 948: Justice for Incarcerated Moms Act of 2021 was introduced to Congress as a part of the Black Maternal Health Momnibus. The Justice for Incarcerated Moms Act aims to improve health care and promote dignity for incarcerated pregnant and parenting people through an array of policies and oversight. In this article, we review and reflect on the components of this bill within their broader public health and reproductive justice contexts. We close with recommendations for policymakers and professionals committed to promoting equity and justice for pregnant and postpartum incarcerated people.

Native American and Non-Native American Women Prisoners, Adverse Childhood Experiences, and the Perpetration of Physical Violence in Adult Intimate Relationships

Native American women are at an especially high risk of lifetime violence, including childhood abuse, intimate partner violence (IPV), and sexual assault, and are overrepresented in the criminal justice system. Yet few studies have examined how the long-term effects of child maltreatment and other adverse childhood experiences (ACEs) affect Native American women prisoners' perpetration of physical violence in adult intimate relationships. This is surprising because ample research illustrates that childhood adverse events, particularly childhood abuse and neglect, have far-reaching effects across the life course and that these experiences are especially apparent in the lives of women involved in the criminal justice system. Using data from a stratified random sample of Native American (n = 92) and non-Native American (n = 264) women prisoners in Oklahoma, we explore the relationships between individual, cumulative, and clusters of ACEs as they relate to the use of physical violence in adult intimate relationships. Utilizing a feminist life course theoretical framework, our findings indicate that ACEs are not only critical to understanding adult IPV but also that the mechanisms and processes underlying the relationships between ACEs and the perpetration of physical violence in adult intimate relationships differ for Native American and non-Native American women. The findings of the current study demonstrate that it is imperative that prison programming includes trauma-informed and trauma-specific interventions targeting Native Americans.

Characterizing Typologies of Polytraumatization: A Replication and Extension Study Examining Internalizing and Externalizing Psychopathology in an Urban Population

A person-centered approach to examining trauma has uncovered typologies of polytraumatization that are differentially associated with psychopathology. However, previous research is limited by narrow conceptualizations of trauma, limited distal outcomes, and underrepresentation of minorities. To address these gaps, we used latent profile analyses to uncover distinct polytraumatization typologies and examine four symptom-based (PTSD, depression, aggression, and substance abuse) and two behavior-based (self-harm, jail counts) outcomes in a sample of low-income adults (n = 7,426, 94% African American). The models were indicated by 19 traumatic experiences (e.g., accident, sexual assault, witnessing/experiencing violence). The best fitting model uncovered five classes: minimal trauma, physical abuse, violence exposure, sexual abuse, and polytrauma. Classes characterized by significant and varied trauma were higher on both internalizing and externalizing psychopathology, while those characterized by specific types of trauma were only higher on one type of psychopathology. Implications for the assessment and treatment of trauma-related disorders are discussed.

VOICES: An efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history

BACKGROUND

Girls have unique developmental pathways to substance use and justice system involvement, warranting gender-responsive intervention. We tested the efficacy of VOICES (a 12-session, weekly trauma-informed, gender-responsive substance use intervention) in reducing substance use and HIV/STI risk behaviors among justice- and school-referred girls.

METHODS

Participants were 113 girls (M_age = 15.7 years, SD = 1.4; 12 % White, 19 % Black, 15 % multi-racial; 42 % Latinx) with a history of substance use referred from juvenile justice (29 %) and school systems (71 %). Study assessments were completed at baseline, 3-, 6- and 9-months follow-up. Primary outcomes included substance use and HIV/STI risk behaviors; secondary outcomes included psychiatric symptoms (including posttraumatic stress) and delinquent acts. We hypothesized that girls randomized to the VOICES (n = 51) versus GirlHealth (attention control; n = 62) condition would report reduced alcohol, cannabis and other substance use, HIV/STI risk behaviors, psychiatric symptoms, and delinquent acts.

RESULTS

Girls randomized to VOICES reported significantly less cannabis use over 9-month follow-up relative to the control condition (time by intervention, p < .01), but there were no between group differences over time in HIV/STI risk behavior. Girls in both conditions reported fewer psychiatric symptoms and delinquent acts over time.

CONCLUSIONS

Data support the use of a trauma-informed, gender-responsive intervention to reduce cannabis use among girls with a substance use history and legal involvement; reducing cannabis use in this population has implications for preventing future justice involvement and improving public health outcomes for girls and young women, who are at disproportionate health and legal risk relative to their male counterparts.

Childhood Adversity and Intimate Partner Violence in Adulthood: The Mediating Influence of PTSD in a Sample of Women Prisoners

Although past research documents strong linkages between adverse childhood experiences (ACEs), posttraumatic stress disorder (PTSD), and adult intimate partner violence (IPV) in the lives of women prisoners, researchers have often neglected to consider the potential mediating role of PTSD in the relationships between ACEs and adult IPV. Using data from a stratified random sample of all incarcerated women in Oklahoma (N = 334), we explore the relationships between ACEs, PTSD symptomology, and adult IPV utilizing a feminist life course theoretical framework. Results indicate that PTSD symptomology fully mediates the relationship between ACEs and adult IPV, suggesting that PTSD may be central to understanding pathways to adult IPV as well as offending and incarceration for women. Implications and suggestions for policy and future research are offered.

Trajectories of victimization to violence among incarcerated women

INTRODUCTION

Limited research has focused on the trajectories of victimization to violence in women's lives. Furthermore, literature assessing women's use of violence has primarily focused on adult risk factors (e.g., substance use and criminal histories). Drawing from the pathway's framework, we explored the impact of multiple forms of childhood victimization and subsequent harmful behaviors on adult-perpetrated violence among women convicted of violent or serious crimes.

METHODS

This secondary data analysis included a sample of 1118 incarcerated women from two prisons. Based on prior literature outlining the lifelong negative impact of childhood victimization, we hypothesized that cumulatively, occurrence of abuses, arrest as a minor, number of lifetime arrests, and poly-substance use prior to incarceration, would increase the likelihood of perpetration of multiple forms of violence. GEE regression models were used to examine the relationship between the predictors and adult perpetration of intimidation and physical violence.

RESULTS

Experiences with childhood victimization, early (under age 18) and ongoing criminal justice involvement, and substance use significantly increased the likelihood of adult perpetration of violence, regardless of the type of violence measured (intimidation or physical violence).

CONCLUSION

Given the documented high prevalence of childhood trauma and abuse among justice-involved women, findings from this study can be used to promote the implementation of trauma-specific treatment for at-risk juvenile girls, whose trajectories of violence might be mitigated.

Are We Comparing Apples and Oranges? Exploring Trauma Experienced by Victims of Interpersonal Violence and Abuse and by Court-Involved Women Who Have Used Force in Relationships

Due to the enactment of mandatory and proarrest policies, there has been a sharp increase in the number of women arrested for use of force against an intimate partner. Many of these arrested women are also victims of intimate partner violence (IPV) and experience high levels of trauma and post-traumatic stress disorder (PTSD). Our study explores experiences of two groups: 80 women who self-refer into survivor groups or individual counseling sessions facilitated by a trained counselor and 86 court-involved women who have been arrested on an IPV/abuse (IPV/A)-related charge and (in lieu of more substantial punishment) participate in an intervention/treatment program. The current research asks, "What do trauma measures tell us about women who voluntarily seek IPV/A victim support groups and about women court-mandated to a treatment program?" Using measures of adverse childhood experiences (ACEs), post-trauma distress, and danger assessments, we explore these two groups. Our findings demonstrate that within the three measures used, women who voluntarily sought victim counseling services had a higher mean compared with women arrested for use of force against an intimate partner. Yet, both groups are significantly different from the general population in terms of having experienced significant trauma. Both groups of women report significantly higher levels of ACEs, post-trauma distress, and danger assessments compared with the general population, indicating that women who experience IPV/A or women who use force in relationships may share more similarities than differences. In addition, we explore the ways in which different relationship characteristics and treatment trajectories might help explain the differences present between these two groups of women. We conclude with a discussion of policy and treatment implications.

Childhood emotional neglect and problematic mobile phone use among Chinese adolescents: A longitudinal moderated mediation model involving school engagement and sensation seeking

BACKGROUND

Childhood emotional neglect has been shown to be associated with a range of emotional, behavioral and social problems. We hypothesized that childhood emotional neglect might predispose adolescents to engage in Problematic Mobile Phone Use (PMPU) as a way to meet their needs for relatedness.

OBJECTIVE

Using a longitudinal design, we aimed to reveal the explanatory mechanism in the association between childhood emotional neglect and PMPU among Chinese adolescents, by testing the mediating effect of school engagement and the moderating effect of sensation seeking.

METHODS

Participants were 1987 Chinese adolescents (56.13 % male; M_age at Wave 1 = 12.32) who completed self-report questionnaires regarding childhood emotional neglect, school engagement, PMPU and sensation seeking at three time points in the course of a year.

RESULTS

The results of structural equation modeling (SEM) showed that retrospective reports of childhood emotional neglect at Wave 1 were positively associated with adolescent PMPU at Wave 3, and school engagement at Wave 2 fully mediated the association. Meanwhile, sensation seeking at Wave 3 moderated the pathway from school engagement to later adolescent PMPU in the mediated model. Specifically, the effect of low school engagement on PMPU was stronger for adolescents who reported high sensation seeking.

CONCLUSION

Identifying the processes by which childhood emotional neglect is associated with adolescent PMPU over time has potential applied value for prevention and intervention.

Effectiveness of psychosocial interventions for reducing parental substance misuse

BACKGROUND

Parental substance use is a substantial public health and safeguarding concern. There have been a number of trials of interventions relating to substance-using parents that have sought to address this risk factor, with potential outcomes for parent and child.

OBJECTIVES

To assess the effectiveness of psychosocial interventions in reducing parental substance use (alcohol and/or illicit drugs, excluding tobacco).

SEARCH METHODS

We searched the following databases from their inception to July 2020: the Cochrane Drugs and Alcohol Group Specialised Register; CENTRAL; MEDLINE; Embase; PsycINFO; CINAHL; Applied Social Science (ASSIA); Sociological Abstracts; Social Science Citation Index (SSCI), Scopus, ClinicalTrials.gov, WHO ICTRP, and TRoPHI. We also searched key journals and the reference lists of included papers and contacted authors publishing in the field.

SELECTION CRITERIA

We included data from trials of complex psychosocial interventions targeting substance use in parents of children under the age of 21 years. Studies were only included if they had a minimum follow-up period of six months from the start of the intervention and compared psychosocial interventions to comparison conditions. The primary outcome of this review was a reduction in the frequency of parental substance use.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

We included 22 unique studies with a total of 2274 participants (mean age of parents ranged from 26.3 to 40.9 years), examining 24 experimental interventions. The majority of studies intervened with mothers only (n = 16; 73%). Heroin, cocaine, and alcohol were the most commonly reported substances used by participants. The interventions targeted either parenting only (n = 13; 59%); drug and alcohol use only (n = 5; 23%); or integrated interventions which addressed both (n = 6; 27%). Half of the studies (n = 11; 50%) compared the experimental intervention to usual treatment. Other comparison groups were minimal intervention, attention controls, and alternative intervention. Eight of the included studies reported data relating to our primary outcome at 6- and/or 12-month follow-up and were included in a meta-analysis. We investigated intervention effectiveness separately for alcohol and drugs. Studies were found to be mostly at low or unclear risk for all 'Risk of bias' domains except blinding of participants and personnel and outcome assessment.  We found moderate-quality evidence that psychosocial interventions are probably more effective at reducing the frequency of parental alcohol misuse than comparison conditions at 6-month (mean difference (MD) -0.32, 95% confidence interval (CI) -0.51 to -0.13; 6 studies, 475 participants) and 12-month follow-up (standardised mean difference (SMD) -0.25, 95% CI -0.47 to -0.03; 4 studies, 366 participants). We found a significant reduction in frequency of use at 12 months only (SMD -0.21, 95% CI -0.41 to -0.01; 6 studies, 514 participants, moderate-quality evidence). We examined the effect of the intervention type. We found low-quality evidence that psychosocial interventions targeting substance use only may not reduce the frequency of alcohol (6 months: SMD -0.35, 95% CI -0.86 to 0.16; 2 studies, 89 participants and 12 months: SMD -0.09, 95% CI -0.86 to 0.61; 1 study, 34 participants) or drug use (6 months: SMD 0.01, 95% CI -0.42 to 0.44; 2 studies; 87 participants and 12 months: SMD -0.08, 95% CI -0.81 to 0.65; 1 study, 32 participants). A parenting intervention only, without an adjunctive substance use component, may not reduce frequency of alcohol misuse (6 months: SMD -0.21, 95% CI -0.46 to 0.04, 3 studies; 273 participants, low-quality evidence and 12 months: SMD -0.11, 95% CI -0.64 to 0.41; 2 studies; 219 participants, very low-quality evidence) or frequency of drug use  (6 months: SMD 0.10, 95% CI -0.11 to 0.30; 4 studies; 407 participants, moderate-quality evidence and 12 months: SMD -0.13, 95% CI -0.52 to 0.26; 3 studies; 351 participants, very low-quality evidence). Parents receiving integrated interventions which combined both parenting- and substance use-targeted components may reduce alcohol misuse with a small effect size (6 months: SMD -0.56, 95% CI -0.96 to -0.16 and 12 months: SMD -0.42, 95% CI -0.82 to -0.03; 2 studies, 113 participants) and drug use (6 months: SMD -0.39, 95% CI -0.75 to -0.03 and 12 months: SMD -0.43, 95% CI -0.80 to -0.07; 2 studies, 131 participants). However, this evidence was of low quality. Psychosocial interventions in which the child was present in the sessions were not effective in reducing the frequency of parental alcohol or drug use, whilst interventions that did not involve children in any of the sessions were found to reduce frequency of alcohol misuse (6 months: SMD -0.47, 95% CI -0.76 to -0.18; 3 studies, 202 participants and 12 months: SMD -0.34, 95% CI -0.69 to 0.00; 2 studies, 147 participants) and drug use at 12-month follow-up (SMD -0.34, 95% CI -0.69 to 0.01; 2 studies, 141 participants). The quality of this evidence was low. Interventions appeared to be more often beneficial for fathers than for mothers. We found low- to very low-quality evidence of a reduction in frequency of alcohol misuse for mothers at six months only (SMD -0.27, 95% CI -0.50 to -0.04; 4 studies, 328 participants), whilst in fathers there was a reduction in frequency of alcohol misuse (6 months: SMD -0.43, 95% CI -0.78 to -0.09; 2 studies, 147 participants and 12 months: SMD -0.34, 95% CI -0.69 to 0.00; 2 studies, 147 participants) and drug use (6 months: SMD -0.31, 95% CI -0.66 to 0.04; 2 studies, 141 participants and 12 months: SMD -0.34, 95% CI -0.69 to 0.01; 2 studies, 141 participants).

AUTHORS' CONCLUSIONS

We found moderate-quality evidence that psychosocial interventions probably reduce the frequency at which parents use alcohol and drugs. Integrated psychosocial interventions which combine parenting skills interventions with a substance use component may show the most promise. Whilst it appears that mothers may benefit less than fathers from intervention, caution is advised in the interpretation of this evidence, as the interventions provided to mothers alone typically did not address their substance use and other related needs. We found low-quality evidence from few studies that interventions involving children are not beneficial.

Implementing and Sustaining SHARE: An Exposure-Based Psychotherapy Group for Incarcerated Women Survivors of Sexual Violence

Although incarcerated women are a highly victimized population, therapy for sexual violence victimization (SVV) sequela is not routinely offered in prison. SHARE is a group therapy for SVV survivors that was successfully implemented and sustained in a women's correction center. Here, we aimed to identify implementation factors and strategies that led to SHARE's success and describe incarcerated women's perspectives on the program. We conducted a retrospective process evaluation using interviews structured according to EPIS, a well-established implementation science framework. Participants (N = 22) were incarcerated women, members of the SHARE treatment team, and members of the correction center's leadership, therapeutic team, and volunteer program. Factors that facilitated SHARE implementation varied by EPIS phase and organization. Positive inter-organizational and interpersonal relationships were key across phases, as were the synergies between both the strengths and needs of each organization involved in implementation. Incarcerated women reported a strong need for SHARE and did not report any concerns about receiving trauma therapy in a carceral setting. Therapy for SVV sequelae, including exposure-based therapy, is possible to implement and sustain in carceral settings. Community-academic partnerships may be a particularly feasible way to expand access to SVV therapy for incarcerated women.

The nuanced relationship between adverse childhood experiences and recidivism risk scores among women leaving jail: A preliminary exploration

BACKGROUND

Women with histories of childhood trauma tend to score higher on recidivism risk/needs assessment tools, such as the Level of Service Inventory-Revised: Screening Version (LSI-R: SV). These may affect their chance of leaving custody, but risk scores may be inflated by reliance on additional items which reflect other fixed childhood events.

AIMS

We hypothesised that adverse childhood experiences (ACEs) would be related to immutable risk measures according to the LSI-R: SV, such as juvenile arrest history, rather than more mutable factors, such as criminal attitudes.

METHODS

Two interviewer-administered questionnaires-one about ACEs and one about criminogenic risk and needs-were given to a cohort of women just after release from jail. Phi coefficients were used to test for associations between ? ACE scale scores and scores on the risk tool-the LSI-R: SV.

RESULTS

ACE scale items were related to static risk item scores from the LSI-R: SV, but not to any of the dynamic risk items except psychological health.

CONCLUSIONS

Risk reduction is an important task in the criminal justice system, for which systematic risk assessment is an integral part of decision making. Self-reported experience of psychological health apart, only fixed historical variables were related to estimated recidivism risk. There was no relationship between the mutable constructs of attitudes towards crime or employment status and estimated risk. This raises the question of whether the risk of recidivism is increased when there is a background of childhood trauma. Implications for using risk reduction tools to inform the need for trauma-informed correctional care are discussed. Longitudinal research assessing recidivism is needed to test this further.

The Moderating Effect of Substance Abuse Treatment Engagement on the Connection Between Support From Program Participants and Substance-Related Recidivism for Justice-Involved Women

This study examines the prediction of substance-related technical violations and arrests from (a) a three-dimensional measure of substance abuse treatment engagement-treatment satisfaction, treatment participation, and counselor rapport-and (b) support from peers in the treatment program. The study focuses on 204 women on probation or parole who attended a substance abuse treatment program in the first 9 months of supervision. Data were collected in face-to-face interviews and from official records of violations and arrests. Generalized linear mixed-effects modeling was used to assess the main effects and the interaction effect of within-program peer support and other indicators of engagement as predictors of substance-related technical violations and arrests. Peer support was positively related to violations/arrests when treatment engagement was low. Findings suggest that for women who do not score high in treatment engagement, support from peers is related to increased recidivism, and group treatment may be contraindicated.

Sexual Victimization and Mental Illness Prevalence Rates Among Incarcerated Women: A Literature Review

Incarcerated women evidence high rates of both interpersonal trauma and mental illness. In particular, the rates of sexual violence victimization are so high that some researchers have suggested that sexual abuse may be a pathway to prison for women, likely through the development of mental illness, including substance abuse. This review article summarizes the literature on sexual victimization (n = 32 articles; 28 independent studies) and mental illness (n = 11 articles; 8 independent studies) prevalence among samples of incarcerated women (Ns ≥ 100) in context of methodological choices within included articles. Best estimates for sexual victimization from studies using established survey methods were as follows: 50-66% for child sexual abuse, 28-68% for adult sexual abuse, and 56-82% for lifetime sexual assault. Although data directly comparing prevalence of sexual victimization among incarcerated women to prevalence for other groups are limited, the existing data indicate that incarcerated women have significantly greater exposure than incarcerated men and community samples of women. Moreover, compared to findings from the National Comorbidity Survey-Replication, incarcerated women evidence greater prevalence of most lifetime and current mental illnesses, especially depressive disorders, post-traumatic stress disorder, and substance use disorders. Surprisingly, only two independent studies have investigated the overlap between sexual victimization and mental illness in samples of incarcerated women. Both studies found disproportionally high rates of mental illness among victims of sexual violence. Suggestions and implications for research, policy, and practice are discussed.

Childhood adversity, mental health, and the perpetration of physical violence in the adult intimate relationships of women prisoners: A life course approach

BACKGROUND

Adverse childhood experiences (ACEs) are common, with nearly two-thirds of adult samples reporting exposure to at least one and one-quarter reporting exposure to three or more distinct types of ACEs. ACEs have been linked to various negative outcomes across the life course, including mental health problems, and the perpetration of physical violence in intimate relationships. However, little is known about the relationships between ACEs, PTSD symptomology, and use of physical violence against an adult intimate partner among incarcerated women.

OBJECTIVE

The purpose of this paper is to examine the relationships between ACEs, PTSD symptoms, and the perpetration of the physical violence in the adult intimate relationships of women prisoners.

METHODS

Using data from the 2014 Oklahoma Study of Incarcerated Mothers and Their Children (N = 349) and structural equation modeling (SEM) techniques, we investigate the potential mediating effect of PTSD symptoms in the relationship between ACEs and perpetrating violence against an intimate partner.

RESULTS

Our findings indicate that PTSD symptomology fully mediates the relationship between ACEs and the perpetration of physical violence against an adult intimate partner, indicating that PTSD experiences may be central to understanding women's pathways toward violence.

CONCLUSIONS

Women prisoners who were exposed to ACEs during childhood were at a particularly elevated risk of developing PTSD symptomology and perpetrating physical violence against an adult intimate partner. Based on the current study's findings, treatment programs that address these complex relationships between ACEs, particularly focusing on the central role of mental health in these processes, are needed for incarcerated women.

Impulsivity Mediates the Link between Childhood Sexual Abuse and Juvenile Incarceration among Low-Income African American Women

A history of childhood trauma has been found to have a robust influence on juvenile delinquency, and evidence suggests that childhood sexual abuse is particularly common among female youth involved in the juvenile justice system. The current study sought to investigate impulsivity as a potential mediator of the relationship between childhood sexual abuse (CSA) and juvenile incarceration amongst a community sample of low-income, urban, African American adult women. Although impulsivity has been studied among justice-involved youth, few studies have examined the influence of impulsivity within the relationship between CSA and juvenile incarceration and no known studies have explored their relationship in community populations of African American women with histories of juvenile incarceration. Results revealed that impulsivity mediated the relationship between CSA and previous juvenile incarceration. As an exploratory analysis, overall emotion dysregulation as well as other facets of emotion dysregulation did not serve as significant mediators in this relationship. These findings suggest that difficulties in impulse control may be one mechanism through which childhood sexual abuse increases risk for juvenile justice system involvement among African American women.

Sexual Abuse and Future Mental Health Hospitalization in a Swedish National Sample of Men Who Use Opioids

Experiences of trauma, specifically sexual abuse, have been linked to both mental health and substance use disorders. This study used 14 years of Swedish health registry data to select a sample of adult men who reported frequent opioid use and assessed if those with a self-reported history of sexual abuse had a higher likelihood of hospitalization for a mental health disorder.

No Idle Threat: Coercive Control and Enacted Violence in the Pre-Prison Relationships of Incarcerated Women

While much research documents physical and sexual abusive experiences in the lives of women prisoners, less is known about their experiences with coercive control. Utilizing Dutton, Goodman, and Schmidt's (2008) measures of coercive control and framed by a feminist pathways approach, this study examines the connections between experiences of coercive control and physical and sexual violence in adult intimate relationships, including how women perceive and respond to experiences of coercion. Findings demonstrate how incarcerated women experience significant levels of control, manipulation, threats, and demands from their partners in relation to personal activities, financial resources, interpersonal interactions, illegal activities, and other areas. Moreover, findings show these threats and demands to be aggressively enforced and directly related to physical and sexual violence against these women, as well as threats to the safety and security of their family, friends, and children. Additional findings and details are discussed.

Exploring the contributions and suitability of relational and community-centered fetal alcohol spectrum disorder (FASD) prevention work in First Nation communities

BACKGROUND

This study provides initial evidence of the contributions and suitability of relational, trauma-informed, and community-based approaches for programs aimed at the prevention of future alcohol-and drug-exposed births. Specifically, this study extends understanding of the experiences of mentors providing evidence-based 3-year home visitation services through the Parent-Child Assistance Program (PCAP) in rural and isolated First Nation communities in Alberta, Canada.

METHODS

Using a participatory approach to this research project, we explored existing PCAP services to capture implementation across six rural and isolated Alberta fetal alcohol spectrum disorder (FASD) networks involving First Nation communities over an 8-month period. In total, we generated qualitative data with 35 participants to examine mentors' perceptions of the impacts and suitability of a relational, trauma-informed, and community-based approach to service delivery.

RESULTS

Six major themes were revealed from the thematic analysis as key mechanisms of culturally responsive program delivery across the six FASD networks.

CONCLUSIONS

Relational, trauma-informed, and community-centered FASD prevention programming was perceived to have positive impacts and be well suited for use within Indigenous communities, and allow for service delivery to be locally and culturally responsive.

A PTSD Screen for Forensic Populations

Posttraumatic stress disorder (PTSD) has been observed in a sizable proportion of the U.S. adult correctional population. Jail administrators must pay particularly close attention to inmates with PTSD symptoms, considering these facilities serve as the gateway to the criminal justice system and inmates with PTSD may pose a risk to themselves, other inmates, and staff. The reality of conducting behavioral health assessments in a jail environment is wrought with significant challenges, including limited time. The current study examined prior research on PTSD screening tools to establish an empirical basis for a practical screen to be used among adults recently booked into local jails. Data from a random sample of 283 adults assessed specificity and sensitivity rates of different combinations of criteria. Results indicated a two-item screen achieved an 86.4% sensitivity rate as well as an 80.4% specificity rate. This evidence demonstrates a practical and clinically relevant approach to conducting PTSD screens among adult jail inmates.

Life as she knows it: The effects of adverse childhood experiences on intimate partner violence among women prisoners

Most incarcerated women suffer from adverse childhood experiences (ACEs), such as abuse (e.g., physical, sexual, emotional), neglect, (e.g., physical, emotional), and chaotic home environments (e.g., witnessing domestic violence), and adult intimate partner violence (IPV). Yet the majority of research on the relationship between ACEs and IPV has been limited to non-incarcerated populations. Using data from a stratified random sample of all incarcerated women in Oklahoma (n = 355), we explore the relationships between individual, cumulative, and clusters of ACEs as they relate to multiple forms of IPV in adulthood utilizing a feminist life course theory approach. Our findings indicate that individual ACEs, high accumulation of ACEs (five or more), and clusters of ACEs are linked to simple assault, aggravated assault, sexual abuse, and psychological abuse in adult intimate relationships in the pre-prison lives of women prisoners suggesting strong support for the use of a feminist life course theory approach in understanding these relationships.

Weight Loss Trajectories and Adverse Childhood Experience among Obese Adolescents with Polycystic Ovary Syndrome

STUDY OBJECTIVE

To examine the effect of childhood trauma and family history of psychiatric illness on weight loss trajectories of obese, female adolescents with polycystic ovary syndrome (PCOS).

DESIGN

Prospective study.

SETTING

PCOS and adolescent medicine outpatient clinics.

PARTICIPANTS

Participants were, on average, 15.8 years of age, 80% Caucasian (39/49 participants), and had a body mass index of 36.8 ± 8.8.

INTERVENTIONS

Healthy Bodies, Healthy Minds is an evidence-based one-on-one intervention consisting of 4 weekly sessions, 4 biweekly sessions, and 3 monthly booster sessions. Each session was 45-60 minutes long with 15-30 minutes of physical activity with a lifestyle coach.

MAIN OUTCOME MEASURES

Paired sample t tests were used to assess group differences in pre- and post-treatment weight between participants reporting childhood trauma and body mass index-matched controls not endorsing trauma. One-way analysis of variance was performed to assess the influence of childhood trauma on weight loss between the 2 groups.

RESULTS

Adolescents without a family history of psychiatric illness lost more weight (mean, -1.28 kg; SD, 6.89) than those who had a family history of psychiatric illness (mean, -0.64 kg; SD, 4.7) from baseline to booster session completion (6 months). However, results of independent t tests did not reveal statistically significant group differences in weight loss from baseline to booster session completion (t₂₁ = 0.51; P = .6).

CONCLUSION

Obese adolescents with PCOS who have experienced childhood trauma can lose weight and acquire its health benefits when enrolled in an intervention addressing weight, mood, and sleep. Family history of psychiatric illness emerged as a potential predictor of lesser weight loss.

Sex differences in traumatic events and psychiatric morbidity associated to probable posttraumatic stress disorder among Latino prisoners

Latinos comprised 17.1% of the U.S. population and 33.1% of US prisoners, yet they are underrepresented in the psychopathology literature. Despite higher rates of trauma among incarcerated individuals than in the general population, most of the previous research in this area focused primarily on women samples, and very few studies examined sex differences in PTSD and traumatic experiences. In addition, there is a need for research assessing traumatic experiences and probable PTSD in men and women Latino inmates to inform culturally competent care and sex sensitive care for this vulnerable and underserved population. Our study examined whether men and women Latino inmates with probable Posttraumatic Stress Disorder (PTSD), based on the cut off 40 or more symptoms on the Davidson Trauma Scale (DTS), differed significantly by the number of event types experienced, the type of potentially traumatizing event, and in co-occurring psychiatric conditions. A multi-stage sample design was used to select a probabilistic sample of 1,331 inmates from 26 penal institutions in PR of which 1179 participated in the study. Bivariate associations were calculated for each type of traumatic event and probable PTSD. Mean number of types of potentially traumatizing event experienced was comparable for both sexes (F = 3.83, M = 3.74) yet sex differences were found in the nature of the event. Women with probable PTSD had higher rates of experiencing rape and sexual abuse. Men had higher rates of experiencing combat in war, a life-threatening accident, of witnessing violence, and being threatened with a weapon. Men with significant ADHD symptoms in childhood and with Generalized Anxiety Disorder (GAD) during adulthood were almost 5 and 7 times as likely to score above threshold on the DTS whereas women were >3 times as likely in the presence of ADHD symptoms in childhood or depression during adulthood. This study underscores the need to improve understanding of the clinical manifestations of trauma and co-occurring psychiatric conditions for appropriate sex sensitive interventions targeting Latinos living in prisons.

Investigating the usefulness of trauma-focused cognitive behavioral therapy in adolescent residential care

OBJECTIVE

This study investigated the usefulness of the trauma intervention, trauma-focused cognitive behavioral therapy (TF-CBT), for adolescents in residential treatment.

METHOD

The study employed a secondary analysis of 132 adolescent trauma cases collected from youth while in a residential treatment facility in Mississippi.

RESULTS

Analysis indicated that clients showed significant decreases in posttraumatic stress disorder (PTSD) severity scores after receiving TF-CBT in residential care. PTSD severity scores were significantly higher for the residential care sample as compared to the National Child Traumatic Stress Network's average baseline score. Females reported significantly higher PTSD and substance use scores than males. PTSD baseline scores, substance use scores, and gender contributed significantly to the prediction of PTSD outcomes post intervention.

CONCLUSION

Implications, based on study findings, to enhance services for traumatized youth in residential care were explored and discussed.

A Brief Assessment for HIV Risk: The TCU HVHP Form

Targeted HIV screens may help identify some risk-related concerns of drug-using offenders. The present study describes the Texas Christian University HIV/Hepatitis Risk Assessment (TCU HVHP) form, a 19-item self-report instrument measuring HIV and hepatitis risks based on a sample (N = 1,056) of offenders in eight prisons. Principal components analysis indicated four scales (Injection Risk, Condom Attitudes, Sex Risk, and AIDS Concern) with reliable psychometric properties with coefficient α reliabilities ranging from .72 to .88. Concurrent validities indicated the four scales were related to motivation for treatment, level of drug use, psychosocial functioning, and criminal thinking, although the patterns varied by gender. The TCU HVHP Form should be attractive to programs needing a brief assessment measuring HIV risk behaviors, attitudes toward condom use, and concerns about acquiring and transmitting HIV.

An Examination of Women Ex-Offenders With Methadone Histories

Criminal (drug and prostitution) charges, employment levels (weekly hours), recent substance use in the past 6 months, and primary sources of income were examined among a sample ( n = 106) of women ex-offenders who had opioid use disorders with and without methadone histories. A general linear model was tested to examine differences in relation to methadone use history. Results from a one-way MANCOVA found that those with methadone histories reported significantly higher levels of drug and prostitution charges than those without any methadone history, but no significant differences in terms of weekly hours of employment or recent substance use were observed between groups. Women ex-offenders with methadone histories reported various sources of income beyond employment, and proportionally, more of these women reported prostitution as a primary source of income. Findings suggest that methadone maintenance treatments are not sufficient in meeting the needs of women ex-offenders.

Affect recognition among adolescents in therapeutic schools: relationships with posttraumatic stress disorder and conduct disorder symptoms

BACKGROUND

Posttraumatic stress disorder (PTSD) and conduct disorder (CD) symptoms often co-occur in adolescence, but little is known about whether they show common or distinct emotional processing deficits.

METHOD

We examined the effects of PTSD and CD symptoms on facial affect processing in youth with emotional and behavior problems. Teens enrolled in therapeutic day schools (N = 371; ages 13-19) completed a structured diagnostic assessment and the Diagnostic Analysis of Nonverbal Accuracy-2 facial affect recognition task.

RESULTS

PTSD symptoms were associated with deficits in the recognition of angry facial expressions, specifically the false identification of angry faces as fearful. CD symptoms were associated with greater difficulty correctly identifying sadness.

CONCLUSIONS

Findings suggest specificity in the relationships of PTSD and CD symptoms with emotional processing.

Examining the Relationship Between Childhood Victimization, High-Risk Behaviors, and Health Among Criminal Justice-Involved Women

The purpose of this study was to develop and test a conceptual model of the pathways through which childhood victimization influences adult health outcomes. Specifically, measures of high-risk behaviors, tobacco use, alcohol use, illegal substance use, and HIV risk behaviors were hypothesized to mediate the relationship between childhood victimization and adult physical health. The sample consisted of 406 women on probation and parole with a history of childhood victimization in Jefferson County, Kentucky. Structural equation modeling was used to examine the relationship between childhood victimization, high-risk behaviors, and physical health outcomes. The findings indicate partial mediation, with health risk behaviors accounting for 12.5% of the variance in the relationship between childhood victimization and health outcomes. Implications for policy and treatment practice in the health and criminal justice arena are discussed.

Measuring affiliation in group therapy for substance use disorders in the Women's Recovery Group study: Does it matter whether the group is all-women or mixed-gender?

BACKGROUND AND OBJECTIVES

A Stage II, two-site randomized clinical trial compared the manualized, single-gender Women's Recovery Group (WRG) to mixed-gender group therapy (Group Drug Counseling; GDC) and demonstrated efficacy. Enhanced affiliation and support in the WRG is a hypothesized mechanism of efficacy. This study sought to extend results of the previous small Stage I trial that showed the rate of supportive affiliative statements occurred more frequently in WRG than GDC.

METHODS

Participants (N = 158; 100 women, 58 men) were 18 years or older, substance dependent, and had used substances within the past 60 days. Women were randomized to WRG (n = 52) or GDC (n = 48). Group therapy videos were coded by two independent raters; Rater 1 coded 20% of videos (n = 74); Rater 2 coded 25% of videos coded by Rater 1 (n = 19).

RESULTS

The number of affiliative statements made in WRG was 66% higher than in GDC. Three of eight affiliative statement categories occurred more frequently in WRG than GDC: supportive, shared experience, and strategy statements.

DISCUSSION AND CONCLUSIONS

This larger Stage II trial provided a greater number of group therapy tapes available for analysis. Results extended our previous findings, demonstrating both greater frequency of all affiliative statements, as well as specific categories of statements, made in single-gender WRG than mixed-gender GDC.

SCIENTIFIC SIGNIFICANCE

Greater frequency of affiliative statements among group members may be one mechanism of enhanced support and efficacy in women-only WRG compared with standard mixed-gender group therapy for substance use disorders. (Am J Addict 2016;25:573-580).

The Effects of Childhood and Adolescent Adversity on Substance Use Disorders and Poor Health in Early Adulthood

Childhood and adolescent adversity have been shown to predict later mental and physical health outcomes. Understanding which aspects and developmental timings of adversity are important, and the mechanisms by which they have their impact may help guide intervention approaches. A large subset of adolescents (N = 457; Female 68.9 %) from the 10-year longitudinal Youth Emotion Project was examined to better understand the associations among childhood/adolescent adversity, substance use disorder, and later health quality. Adolescent (but not childhood) adversities were associated with poorer health in late adolescence/early adulthood, adolescent adversities were associated with subsequent onset of substance use disorder, and adolescent adversities continued to be associated with poorer health in late adolescence/early adulthood after accounting for the variance explained by substance use disorder onset. These associations were observed after statistically accounting for emotional disorders and socioeconomic status. Specific domains of adversity uniquely predicted substance use disorder and poorer health outcomes. In contrast with current recent research, our findings suggest the association between childhood/adolescent adversity and poorer health outcomes in late adolescence and emerging adulthood are not entirely accounted for by substance use disorder, suggesting efforts to curtail family-based adolescent adversity may have downstream health benefits.

A Qualitative Exploration of U.K. Prisoners’ Experiences of Substance Misuse and Mental Health Difficulties, and the Breaking Free Health and Justice Interventions

This qualitative study explored prisoners’ lived experiences of substance use and mental health difficulties and aimed to examine perceived links between these two areas and how they might be associated with recovery during engagement with the Breaking Free Health and Justice (BFHJ) treatment programs. Interviews were conducted with 32 prisoners receiving treatment for substance use in North-West England. Emerging from prisoners’ interviews were themes relating to difficult life experiences from childhood into adulthood, how these experiences played a role in the emergence of their multiple and complex difficulties, their treatment experiences, and how their current involvement with the criminal justice system acted as a catalyst for positive change, including engagement with the BFHJ programs. This study identified the roles of substance use and mental health difficulties in the lives of participants, identified how their multiple and complex difficulties might be addressed, and provided insights into prisoners’ interpretations of their life experiences.

Trauma and Morbidities Among Female Detainees in a Large Urban Jail

Using data from 810 women entering the Department of Women's Justice Services in the Cook County Jail (Chicago) from 2010 to 2013, this study examines patterns of trauma exposure and the relationship between trauma exposure and mental disorders. Female detainees averaged 6.1 (SD = 4.90) types of trauma in their lifetimes, with greater trauma exposure associated with earlier age of trauma onset, more recent trauma exposure, and higher rates of fear for life or injury. Higher rates of trauma exposure were also correlated with higher rates of past-year symptoms of posttraumatic stress disorder as well as other internalizing, externalizing, and substance use disorders. Behavioral health programming for female detainees in jail settings should include more trauma-sensitive mental health and substance use disorder treatments.

Continuing Care and Trauma in Women Offenders' Substance Use, Psychiatric Status, and Self-Efficacy Outcomes

Using secondary data analysis of 3 separate trauma-informed treatment programs for women offenders, we examine outcomes between those who received both prison and community-based substance abuse treatment (i.e., continuing care; n = 85) and those who received either prison or community aftercare treatment (n = 108). We further account for differences in trauma exposure to examine whether continuing care moderates this effect on substance use, psychiatric severity, and self-efficacy outcomes at follow-up. The main effect models of continuing care showed a significant association with high psychiatric status and did not yield significant associations with substance use or self-efficacy. However, the interaction between trauma history and continuing care showed significant effects on all 3 outcomes. Findings support the importance of a continuing care treatment model for women offenders exposed to multiple forms of traumatic events, and provide evidence of the effectiveness of integrating trauma-informed treatment into women's substance abuse treatment.

Cumulative burden of lifetime adversities: Trauma and mental health in low-SES African Americans and Latino/as

This study examined the utility of a lifetime cumulative adversities and trauma model in predicting the severity of mental health symptoms of depression, anxiety, and posttraumatic stress disorder. We also tested whether ethnicity and gender moderate the effects of this stress exposure construct on mental health using multigroup structural equation modeling. A sample of 500 low-socioeconomic status African American and Latino men and women with histories of adversities and trauma were recruited and assessed with a standard battery of self-report measures of stress and mental health. Multiple-group structural equation models indicated good overall model fit. As hypothesized, experiences of discrimination, childhood family adversities, childhood sexual abuse, other childhood trauma, and chronic stresses all loaded on the latent cumulative burden of adversities and trauma construct (CBAT). The CBAT stress exposure index in turn predicted the mental health status latent variable. Although there were several significant univariate ethnic and gender differences, and ethnic and gender differences were observed on several paths, there were no significant ethnic differences in the final model fit of the data. These findings highlight the deleterious consequences of cumulative stress and trauma for mental health and underscore a need to assess these constructs in selecting appropriate clinical interventions for reducing mental health disparities and improving human health.

Gender differences in treatment retention among individuals with co-occurring substance abuse and mental health disorders

BACKGROUND

A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. Although prior research indicates that women and men differ in their substance abuse treatment experiences, our knowledge of individuals with co-occurring substance abuse and mental health disorders as well as those attending private residential treatment is limited.

OBJECTIVES

The purpose of this study is to examine gender differences on treatment retention for individuals with co-occurring substance abuse and mental health disorders who participate in private residential treatment.

METHODS

The participants were 1,317 individuals (539 women and 778 men) with co-occurring substance abuse and mental health disorders receiving treatment at three private residential treatment centers. Bivariate analyses, life tables, and Cox regression (survival analyses) were utilized to examine gender effects on treatment retention, and identify factors that predict treatment retention for men and women.

RESULTS

This study found that women with co-occurring disorders were more likely to stay longer in treatment when compared to men. The findings indicate the factors influencing length of stay differ for each gender, and include: type of substance used prior to admission; Addiction Severity Index Composite scores; and Readiness to Change/URICA scores. Age at admission was a factor for men only. CONCLUSIONS/IMPORTANCE: These findings can be incorporated to develop and initiate program interventions to minimize early attrition and increase overall retention in private residential treatment for individuals with co-occurring substance use and mental health disorders.

Social Support Among Substance Using Women with Criminal Justice Involvement

Social support types (abstinence, appraisal, belonging, tangible) were analyzed among a sample of women with criminal justice involvement and substance use disorders (n = 200). Hierarchical linear regression was conducted to examine social support types in relation to changes in abstinence self-efficacy while controlling for incarceration histories. Only abstinence social support and tangible social support predicted significant increases in abstinence self-efficacy, with tangible support accounting for more variance in the analytic model. Findings suggest women with criminal justice involvement who have substance use disorders have basic needs that if met would have an indirect effect on their recovery. Implications for treatment and research are discussed.

Multilevel challenges to engagement in HIV care after prison release: a theory-informed qualitative study comparing prisoners' perspectives before and after community reentry

Background

Although prison provides the opportunity for HIV diagnosis and access to in-prison care, following release, many HIV-infected inmates experience clinical setbacks, including nonadherence to antiretrovirals, elevations in viral load, and HIV disease progression. HIV-infected former inmates face numerous barriers to successful community reentry and to accessing healthcare. However, little is known about the outcome expectations of HIV-infected inmates for release, how their post-release lives align with pre-release expectations, and how these processes influence engagement in HIV care following release from prison.

Methods

We conducted semi-structured interviews (24 pre- and 13 post-release) with HIV-infected inmates enrolled in a randomized controlled trial of a case management intervention to enhance post-release linkage to care. Two researchers independently coded data using a common codebook. Intercoder reliability was strong (kappa = 0.86). We analyzed data using Grounded Theory methodology and Applied Thematic Analysis. We collected and compared baseline sociodemographic and behavioral characteristics of all cohort participants who did and did not participate in the qualitative interviews using Fisher’s Exact Tests for categorical measures and Wilcoxon rank-sum tests for continuous measures.

Results

Most participants were heterosexual, middle-aged, single, African American men and women with histories of substance use. Substudy participants were more likely to anticipate living with family/friends and needing income assistance post-release. Most were taking antiretrovirals prior to release and anticipated needing help securing health benefits and medications post-release. Before release, most participants felt confident they would be able to manage their HIV. However, upon release, many experienced intermittent or prolonged periods of antiretroviral nonadherence, largely due to substance use relapse or delays in care initiation. Substance use was precipitated by stressful life experiences, including stigma, and contact with drug-using social networks. As informed by the Social Cognitive Theory and HIV Stigma Framework, findings illustrate the reciprocal relationships among substance use, experiences of stigma, pre- and post-release environments, and skills needed to engage in HIV care.

Conclusion

These findings underscore the need for comprehensive evidence-based interventions to prepare inmates to transition from incarceration to freedom, particularly those that strengthen linkage to HIV care and focus on realities of reentry, including stigma, meeting basic needs, preventing substance abuse, and identifying community resources.

Does gender matter? Exploring mental health recovery court legal and health outcomes

BACKGROUND

Based upon therapeutic justice principles, mental health courts use legal leverage to improve access and compliance to treatment for defendants who are mentally ill. Justice-involved women have a higher prevalence of mental illness than men, and it plays a greater role in their criminal behavior. Despite this, studies examining whether women respond differently than men to mental health courts are lacking. Study goals were to examine gender-related differences in mental health court participation, and in criminal justice, psychiatric and health-related outcomes.

METHODS

This study utilized a quasi-experimental pre-posttest design without a control group. The data were abstracted from administrative records of Kalamazoo Community Mental Health and Substance Abuse agency, the county jail and both county hospitals, 2008 through 2011. Generalized estimating equation regression was used to assess gender-differences in pre-post program outcomes (jail days, psychiatric and medical hospitalization days, emergency department visits) for the 30 women and 63 men with a final mental health court disposition.

RESULTS

Program-eligible females were more likely than males to become enrolled in mental health court. Otherwise they were similar on all measured program-participation characteristics: treatment compliance, WRAP participation and graduation rate. All participants showed significant reductions in emergency department visits, but women-completers had significantly steeper drops than males: from 6.7 emergency department visits to 1.3 for women, and from 4.1 to 2.4 for men. A similar gender pattern emerged with medical-hospitalization-days: from 2.2 medical hospital days down to 0.1 for women, and from 0.9 days up to 1.8 for men. While women had fewer psychiatric hospitalization days than men regardless of program involvement (2.5 and 4.6, respectively), both genders experienced fewer days after MHRC compared to before. Women and men showed equal gains from successful program completion in reduced jail days.

CONCLUSIONS

Despite similar participation characteristics, findings point to greater health gains by female compared to male participants, and to lower overall psychiatric acuity. Mental-health-court participation was associated with decreased psychiatric hospitalization days and emergency department visits. Successful program completion correlated to fewer jail days for both women and men.

Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women

OBJECTIVES

This randomized controlled study compared acceptance and commitment therapy (ACT), cognitive-behavioral therapy (CBT), and a control group.

METHOD

The participants were 50 incarcerated women diagnosed with current substance use disorder. Two psychologists carried out pre- and posttreatment assessment and a 6-month follow-up assessment using the following instruments: Anxiety Sensitivity Index, Addiction Severity Index-6, Mini International Neuropsychiatric Interview, and Acceptance and Action Questionnaire.

RESULTS

The study shows that the women who received treatment benefited differentially from the interventions. At posttreatment, CBT was more effective than ACT in reducing anxiety sensitivity; however, at follow-up, ACT was more effective than CBT in reducing drug use (43.8 vs. 26.7%, respectively) and improving mental health (26.4% vs. 19.4%, respectively).

CONCLUSION

ACT may be an alternative to CBT for treatment of drug abuse and associated mental disorders. In fact, at long-term, ACT may be more appropriate than CBT for incarcerated women who present serious problems.

Reducing risky relationships: a multisite randomized trial of a prison-based intervention for reducing HIV sexual risk behaviors among women with a history of drug use

Women involved in the criminal justice system, particularly those with a history of drug use, are at elevated risk of HIV infection, yet few HIV prevention interventions have been tailored for delivery to incarcerated women. Drawing on the Relational Model, the Reducing Risky Relationships for HIV (RRR-HIV) intervention was developed and evaluated in a multisite randomized clinical trial. Women with weekly drug use prior to incarceration (n = 444) who were incarcerated within correctional institutions in four states were randomized to (1) the RRR-HIV intervention consisting of an HIV educational video, five group sessions, and one postrelease booster session or (2) a control condition consisting of the HIV educational video. The RRR-HIV intervention combined didactic and interactive content regarding seven "thinking myths" about intimate relationships that may result in decisions to engage in risky sexual behaviors. Data were collected while women were still incarcerated and approximately 90 days following release from prison by trained interviewers. A negative binomial regression (NBR) model of unprotected sexual behaviors at the 90-day follow-up indicated that RRR-HIV participants reported fewer unprotected sexual behaviors than women in the control condition once the analysis was adjusted for study site. Future studies should examine the sustainability of the RRR-HIV intervention's effect on risk reduction. Implementation research is needed to determine whether delivery of this intervention by correctional staff or peers, rather than research staff, yields similar reductions in unprotected sexual behaviors.