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Hwang YIJ, Hampton S, Withall AL, Snoyman P, Forsyth K, Butler T. Multi-sector stakeholder consensus on tackling the complex health and social needs of the growing population of people leaving prison in older age. HEALTH & JUSTICE 2024; 12:17. [PMID: 38639865 PMCID: PMC11027373 DOI: 10.1186/s40352-024-00271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND As populations age globally, cooperation across multi-sector stakeholders is increasingly important to service older persons, particularly those with high and complex health and social needs. One such population is older people entering society after a period of incarceration in prison. The 'ageing epidemic' in prisons worldwide has caught the attention of researchers, governments and community organisations, who identify challenges in servicing this group as they re-enter the community. Challenges lie across multiple sectors, with inadequate support leading to dire consequences for public health, social welfare and recidivism. This is the first study to bring together multi-sector stakeholders from Australia to form recommendations for improving health and social outcomes for older people re-entering community after imprisonment. RESULTS A modified nominal group technique was used to produce recommendations from N = 15 key stakeholders across prison health, corrections, research, advocacy, aged care, community services, via online workshops. The importance and priority of these recommendations was validated by a broader sample of N = 44 stakeholders, using an online survey. Thirty-six recommendations for improving outcomes for this population were strongly supported. The key issues underlying the recommendations included: improved multi-stakeholder systems and services, targeted release preparation and practices that ensure continuity of care, advocacy-focused initiatives in the community, and extended funding for effective programs. CONCLUSIONS There is consensus across stakeholders on ways forward, with intervention and policy updates required at the individual, systems and community levels. These recommendations entail two important findings about this population: (1) They are a high-needs, unique, and underserved group at risk of significant health and social inequity in the community, (2) Multi-sector stakeholder cooperation will be crucial to service this growing group.
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Affiliation(s)
- Ye In Jane Hwang
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia.
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Stephen Hampton
- Justice Health & Forensic Mental Health Network, Matraville, NSW, 2036, Australia
| | - Adrienne Lee Withall
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, 2052, Australia
| | | | - Katrina Forsyth
- Health and Justice Research Network, University of Manchester, Manchester, M13 9PL, UK
| | - Tony Butler
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, 2052, Australia
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Baggio S, Billieux J, Dirkzwager A, Iglesias K, Moschetti K, Perroud N, Schneider M, Vernaz N, Wolff H, Heller P. Protocol of a monocentric, double-blind, randomized, superiority, controlled trial evaluating the effect of in-prison OROS-methylphenidate vs. placebo treatment in detained people with attention-deficit hyperactivity disorder (BATIR). Trials 2024; 25:23. [PMID: 38178233 PMCID: PMC10765778 DOI: 10.1186/s13063-023-07827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/23/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is characterized by difficulty paying attention, poor impulse control, and hyperactive behavior. It is associated with several adverse health and social outcomes and leads to an increased risk of criminality and recidivism. Worldwide, ADHD is thus highly prevalent in prisons. However, ADHD treatment has been neglected in such environments. Stimulant medications such as osmotic-release oral system methylphenidate (OROS-MPH) are first-line treatments in the general population, but they are under-prescribed in prisons due to concerns about abuse, even though such claims are not empirically supported. This project aims to compare the efficacy of a 3-month in-prison OROS-MPH vs. placebo treatment on the severity of core ADHD symptoms and relevant in- and post-prison outcomes. METHODS This study is a phase III, double-blinded, randomized, superiority, controlled trial of OROS-MPH vs. placebo. After randomization, the participants will receive 3 months of treatment with OROS-MPH or placebo (1:1 ratio) while incarcerated. Upon release, all participants will be offered the treatment (OROS-MPH) for 1 year but will remain blinded to their initial study group. The study will be conducted at the Division of Prison Health, Geneva, Switzerland, among incarcerated men (n = 150). Measures will include (1) investigator-rated ADHD symptoms, (2) acute events collected by the medical and prison teams, (3) assessment of the risk of recidivism, (4) medication side effects, (5) medication adherence, (6) study retention, (7) health care/prison costs, and (8) 1-year recidivism. Analyses will include bivariable and multivariable modeling (e.g., regression models, mixed-effects models, survival analyses) and an economic evaluation (cost-benefit analysis). DISCUSSION We expect that early identification and treatment of ADHD in prison will be an important public health opportunity and a cost-effective approach that is likely to reduce the vulnerability of incarcerated individuals and promote pathways out of criminal involvement. The study will also promote standards of care for people with ADHD in prison and provide recommendations for continuity of care after release. TRIAL REGISTRATION ClinicalTrials.gov NCT05842330 . Registered on June 5, 2023. Kofam.ch SNCTP000005388. Registered on July 17, 2023.
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Affiliation(s)
- Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
- Laboratory of Population Health (#PopHealthLab), University of Fribourg, Fribourg, Switzerland.
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland.
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
| | - Anja Dirkzwager
- Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, The Netherlands
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| | - Karine Moschetti
- Health Technology Assessment Unit, University Hospital of Lausanne, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marie Schneider
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
- Medication adherence and Interprofessionality lab, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Nathalie Vernaz
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals, Geneva, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Kim SB, White B, Roberts J, Day CA. Substance use among pregnant women in NSW prisons. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104256. [PMID: 37924608 DOI: 10.1016/j.drugpo.2023.104256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION AND AIMS Little is published about pregnant women in custody. Existing data on the prevalence of substance use among incarcerated pregnant women or their needs are scant. This study sought to determine the prevalence and characteristics of women with substance use histories who present to prison pregnant in New South Wales (NSW), Australia. DESIGN AND METHODS A retrospective review of prison medical health records was completed for pregnant women entering New South Wales custodial settings between January 2020 and June 2021. RESULTS We identified 158 prison receptions among 141 pregnant women (median age 28 years [IQR 25-33 years]), 42 % identified as Aboriginal or Torres Strait Islander. Eighty four percent of the women (n = 119) reported recent use of one or more than one substance and 36 % had injected drugs. The most commonly used substances were (meth)amphetamine (60 %), cannabis (40 %) and opioids (28 %). We found discrepancies between drug problems self-reported at reception screening on entry to prison and self-reported drug use collected during the subsequent drug and alcohol specialist assessment while incarcerated. Most (88 %) women described their current pregnancy as unplanned and half (52 %) were unaware they were pregnant before incarceration. CONCLUSIONS These findings highlight the high prevalence of substance use in incarcerated pregnant women and that many women are unaware of their pregnancy prior to incarceration. Findings emphasize the importance of timely and appropriate drug and alcohol assessment and treatment to minimize harm for both the mother and foetus and also underscore the urgent need for enhanced access to contraception for these women.
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Affiliation(s)
- So Bi Kim
- Drug and Alcohol Services, Justice Health Forensic Mental Health Network, Sydney, NSW, Australia; Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, NSW, Australia.
| | - Bethany White
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, NSW, Australia
| | - Jillian Roberts
- Drug & Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Carolyn A Day
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, NSW, Australia
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Majeed T, Breuer E, Edwards L, Remond M, Taylor J, Zeki R, Hampton S, Grant L, Sherwood J, Baldry E, Sullivan E. Developing best practice principles for the provision of programs and services to people transitioning from custody to the community: study protocol for a modified Delphi consensus exercise. BMJ Open 2023; 13:e067366. [PMID: 37270198 DOI: 10.1136/bmjopen-2022-067366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION There is a lack of standard nomenclature and a limited understanding of programmes and services delivered to people in prisons as they transition into the community to support their integration and reduce reoffending related risk factors. The aim of this paper is to outline the protocol for a modified Delphi study designed to develop expert consensus on the nomenclature and best-practice principles of programmes and services for people transitioning from prison into the community. METHODS AND ANALYSIS An online, two-phase modified Delphi process will be conducted to develop an expert consensus on nomenclature and the best-practice principles for these programmes. In the preparatory phase, a questionnaire was developed comprising a list of potential best-practice statements identified from a systematic literature search. Subsequently, a heterogeneous sample of experts including service providers, Community and Justice Services, Not for Profits, First Nations stakeholders, those with lived experience, researchers and healthcare providers will participate in the consensus building phase (online survey rounds and online meeting) to achieve consensus on nomenclature and best-practice principles. Participants will indicate, via Likert scale, to what extent they agree with nomenclature and best-practice statements. If at least 80% of the experts agree to a term or statement (indicated via Likert scale), it will be included in a final list of nomenclature and best-practice statements. Statements will be excluded if 80% experts disagree. Nomenclature and statements not meeting positive or negative consensus will be explored in a facilitated online meeting. Approval from experts will be sought on the final list of nomenclature and best-practice statements. ETHICS AND DISSEMINATION Ethical approval has been received from the Justice Health and Forensic Mental Health Network Human Research Ethics Committee, the Aboriginal Health and Medical Research Council Human Research Ethics Committee, the Corrective Services New South Wales Ethics Committee and the University of Newcastle Human Research Ethics Committee. The results will be disseminated via peer-reviewed publication.
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Affiliation(s)
- Tazeen Majeed
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Erica Breuer
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Layla Edwards
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Marc Remond
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Jo Taylor
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Reem Zeki
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
| | - Stephen Hampton
- Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
| | - Luke Grant
- Office of the Deputy Commissioner, Corrective Services NSW, Sydney, New South Wales, Australia
| | - Juanita Sherwood
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Jumbunna Institute for Indigenous Education and Research, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Eileen Baldry
- School of Social Sciences, Faculty of Arts and Social Sciences, UNSW Australia, Sydney, New South Wales, Australia
| | - Elizabeth Sullivan
- College of Health Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
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Curtis M, Wilkinson AL, Dietze P, Stewart AC, Kinner SA, Winter RJ, Aitken C, Walker SJ, Cossar RD, Butler T, Stoové M. Is use of opioid agonist treatment associated with broader primary healthcare use among men with recent injecting drug use histories following release from prison? A prospective cohort study. Harm Reduct J 2023; 20:42. [PMID: 36978089 PMCID: PMC10044112 DOI: 10.1186/s12954-023-00773-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND A precipitous decline in health status among people recently released from prison is common. In Victoria, Australia, opioid agonist treatment (OAT) in the community involves frequent contact with primary care, potentially facilitating broader use of primary healthcare services. Among a cohort of men who injected drugs regularly pre-imprisonment, we estimated differences in rates of primary healthcare use and medication dispensation between people who did and did not receive OAT post-release. METHODS Data came from the Prison and Transition Health Cohort Study. Three-month post-release follow-up interviews were linked with primary care and medication dispensation records. Generalised linear models were fit with one exposure (OAT: none/partial/complete) for 13 outcomes relating to primary healthcare use, pathology testing, and medication dispensation, adjusted for other covariates. Coefficients were reported as adjusted incidence rate ratios (AIRR). RESULTS Analyses included 255 participants. Compared to no OAT use, both partial and complete OAT use were associated with increased rates of standard (AIRR: 3.02, 95%CI: 1.88-4.86; AIRR: 3.66, 95%CI: 2.57-5.23), extended (AIRR: 2.56, 95%CI: 1.41-4.67; AIRR: 2.55, 95%CI: 1.60-4.07) and mental health-related (AIRR: 2.71, 95%CI: 1.42-5.20; AIRR: 2.27, 95%CI: 1.33-3.87) general practitioner (GP) consultations, total medication (AIRR: 1.88, 95%CI: 1.19-2.98; AIRR: 2.40, 95%CI: 1.71-3.37), benzodiazepine (AIRR: 4.99, 95%CI: 2.81-8.85; AIRR: 8.30, 95%CI: 5.28-13.04) and gabapentinoid (AIRR: 6.78, 95%CI: 3.34-13.77; AIRR: 4.34, 95%CI: 2.37-7.94) dispensations, respectively. Partial OAT use was also associated with increased after-hours GP consultations (AIRR: 4.61, 95%CI: 2.24-9.48) and complete OAT use? with increased pathology utilisation (e.g. haematological, chemical, microbiological or immunological tissue/sample testing; AIRR: 2.30, 95%CI: 1.52-3.48). CONCLUSION We observed higher rates of primary healthcare use and medication dispensation among people who reported partial and complete OAT use post-release. Findings suggest that access to OAT post-release may have a collateral benefit in supporting broader health service utilisation, underscoring the importance of retention in OAT after release from prison.
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Affiliation(s)
- Michael Curtis
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- Monash Addition Research Centre, Monash University, Melbourne, VIC, Australia.
| | - Anna L Wilkinson
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Paul Dietze
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Ashleigh C Stewart
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stuart A Kinner
- School of Population Health, Curtin University, Perth, WA, Australia
- Justice Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, QLD, Australia
| | - Rebecca J Winter
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Campbell Aitken
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shelley J Walker
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Reece D Cossar
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Tony Butler
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark Stoové
- Disease Elimination Program, Public Health Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Le Gautier R, Panozzo S, Bryan T, Lethborg C, Philip J. A thematic analysis of hospital medical records of patients with advanced illness experiencing incarceration in the last 3 months of life. Palliat Med 2022; 37:638-645. [PMID: 36476100 DOI: 10.1177/02692163221124033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The constraining prison culture is not, for the most part, conducive to the provision of palliative care for people in prison. AIM This study aimed to explore patterns of palliative and end-of-life care provision for hospitalised prison patients. DESIGN A retrospective qualitative review of hospital medical records to explore the quality of end-of-life care provision for patients experiencing incarceration who died within hospital. Qualitative inductive analysis of record extracts of each patients final 3-months of life was undertaken. SETTING/PARTICIPANTS An Australian metropolitan hospital responsible for providing secondary and tertiary health services for people experiencing incarceration. This study included a systematic sample of male patients experiencing incarceration who died in hospital between 2009 and 2019. RESULTS Medical record extracts of 15 male patients revealed two broad themes: (1) barriers to equitable access to palliative care for incarcerated hospitalised patients; and (2) factors that facilitated quality end-of-life care for patients and families. Barriers included: tensions between balancing risk and humanity; and limited agency over place and death. Conversely, early recognition of deterioration and anticipated dying provided patients and families opportunity to focus on end-of-life goals. CONCLUSIONS Institutional influences of security and control challenged the provision of equitable end-of-life care for people experiencing incarceration. Further research is required to inform, and incorporate, best approaches to identifying patient wishes and advance planning into care within, or despite, the constrains of incarceration. Policy reform and a coordinated, best practice approach to the management of end-of-life care for people experiencing incarceration is needed.
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Affiliation(s)
- Roslyn Le Gautier
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Stacey Panozzo
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Tamsin Bryan
- Palliative Care Services, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Carrie Lethborg
- Social Work, St Vincent's Health Australia, Melbourne, VIC, Australia.,College of Health & Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Jennifer Philip
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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Hsieh FC, Lin LP, Wu TP, Hsu SW, Lai CY, Lin JD. Factors Associated with patient satisfaction towards a prison detention Clinic Care among male drug-using inmates. BMC Health Serv Res 2022; 22:1255. [PMID: 36253743 PMCID: PMC9578243 DOI: 10.1186/s12913-022-08609-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 09/26/2022] [Indexed: 12/02/2022] Open
Abstract
This study assessed patient satisfaction and its associated factors among male drug-using inmates utilizing a prison detention clinic in Taiwan. A cross-sectional design and structured questionnaire were employed to recruit 580 drug-using inmates into the study. The Patient Satisfaction Questionnaire Short Form (PSQ-18), developed by the RAND Corporation, was used as the basis for the short scale of patient satisfaction, and the research data were analyzed using the SPSS for Windows 20.0 statistical software package. The results showed that the research subjects had low patient satisfaction in all the factors assessed compared with the scale’s general norms. Among the original seven satisfaction subscales in this study, the highest score was for the financial aspects, and the lowest was for the amount of time spent with doctors. This study also investigated satisfaction with medical lab exams and the pharmacy at the prison’s clinic, and the satisfaction scores were higher than the original seven subscales. In multiple logistic regression analyses, the final model indicated that the inmates undergoing observed rehabilitation (OR = 13.837, 95% CI = 2.736–69.983) were more likely satisfied with prison detention clinic c than those serving prison sentences. Those inmates with custodial deposits (high vs. low; OR = 1.813, 95% CI = 1.038–3.168), and meet their physical health needs (met vs. unmet; OR = 4.872, 95% CI = 2.054–11.560) had significant correlated with detention clinic care satisfactory level. Although there is only one study setting cannot give a generalizability for people who are incarcerated in Taiwan, this study highlights that the prison authorities should scrutinize factors associated with detention clinic care satisfaction, such as the type of inmate, economic status in the prison, self-reported health status, and their physical health needs, to increase the level of patient satisfaction.
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Affiliation(s)
- Fang-Chun Hsieh
- Civilian Division, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Lan-Ping Lin
- Institute of Long-Term Care, MacKay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi District, 252, New Taipei City, Taiwan
| | - Te-Pin Wu
- Sanitation and Health Section, Sindian Drug Abuser Treatment Center, Agency of Corrections, Ministry of Justice, New Taipei City, Taiwan
| | - Shang-Wei Hsu
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Chao-Ying Lai
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Jin-Ding Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan. .,Institute of Long-Term Care, MacKay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi District, 252, New Taipei City, Taiwan.
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Integration, population commissioning and prison health and well-being – an exploration of benefits and challenges through the study of telemedicine. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-11-2021-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions. It also aims to understand how closer integration between prison and ICS could improve cross system working between community and prison healthcare teams, and highlights challenges that exist to integration between prison healthcare and ICS.Design/methodology/approachThe study uses evidence from research on the implementation of a pilot study to establish telemedicine secondary care appointments between prisons and an acute trust in one English region (a cross-system intervention). Qualitative interview data were collected from prison (n = 12) and community (n = 8) healthcare staff related to the experience of implementing a cross-system telemedicine initiative. Thematic analysis was undertaken on interview data, guided by an implementation theory and framework.FindingsThe research found four main themes related to the closer integration between prison healthcare and ICS: (1) Recognition of prison health as a priority; (2) Finding a way to reconcile networks and finances between community and prison commissioning; (3) Awareness of prison service influence on NHS healthcare planning and delivery; and (4) Shared investment in prison health can lead to benefits.Originality/valueThis is the first article to provide research evidence to support or challenge the integration of specialist health and justice (H&J) commissioning into local population health.
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Hagos AK, Withall A, Ginnivan NA, Snoyman P, Butler T. Barriers and enablers to health and social services for older prisoners transitioning to community. Int J Prison Health 2022; 18:124-137. [PMID: 38899607 DOI: 10.1108/ijph-08-2021-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE When properly designed and implemented, prison-to-community transition programs targeting older prisoners could potentially save resources, reduce reoffending rates and contribute to improved public protection and safety. However, older prisoners transitioning to community are often neglected and overlooked, and thus, interventions targeted to address their needs are limited. The purpose of this study was to identify barriers and enablers to health and social services for older prisoners transitioning to community. DESIGN/METHODOLOGY/APPROACH A qualitative study was conducted using focus group discussions with corrections officers, community corrections officers and parole officers (n = 32) in four correctional centres, two community corrections offices (CCOs) and one parole unit in New South Wales (NSW) in 2019. The authors used thematic analysis to analyse the findings. FINDINGS The study identified three main themes relating to barriers and enablers: organisational, social and economic and individual and family and seven sub-themes: planning the transition, communication, assisting prisoners, transition programs, officers' knowledge and scope of work, social and economic issues and offenders' conditions. RESEARCH LIMITATIONS/IMPLICATIONS The processes required to ensure effective prison-to-community transition of older prisoners are not well-developed suggesting the need for more systemic and organised mechanisms. Implications of the barriers and enablers for policy, research and practice are discussed. ORIGINALITY/VALUE This study identified a composite of barriers and enablers to health and social services for older prisoners in NSW prisons and CCOs.
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Affiliation(s)
| | - Adrienne Withall
- School of Population Health, University of New South Wales, Sydney, Australia
| | | | - Phillip Snoyman
- State-wide Services, Corrective Services New South Wales, Sydney, Australia
| | - Tony Butler
- Justice Health Research Program, School of Population Health, University of New South Wales, Sydney, Australia
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Winkelman TNA, Dasrath KC, Young JT, Kinner SA. Universal health coverage and incarceration. THE LANCET PUBLIC HEALTH 2022; 7:e569-e572. [DOI: 10.1016/s2468-2667(22)00113-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 02/06/2023] Open
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The health of detainees and the role of primary care: Position paper of the European Forum for Primary Care. Prim Health Care Res Dev 2022; 23:e29. [PMID: 35574709 PMCID: PMC9112672 DOI: 10.1017/s1463423622000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This position paper aims to increase awareness among primary care practitioners and policymakers about the specific and complex health needs of people who experience incarceration. We focus on the importance of primary care and of continuity of care between prison and community. We highlight what is known from the literature on the health of people who experience incarceration, on the organisation of prison health care, and on the role of primary care both during and after detention. We present three case descriptions of detainees' encounters with the organisation of prison health care in three European countries. Finally, we describe the position that the European Forum for Primary Care takes. Prisoners and ex-prisoners have a worse physical and mental health compared with a cross-section of the population. However, access to good quality treatment and care is often worse than in the outside situation. In particular, well-organised primary care in the prison context could benefit prisoners and, indirectly, society at large. Moreover, continuity of care between the community and the prison situation needs improvement.
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Edwards L, Jamieson SK, Bowman J, Chang S, Newton J, Sullivan E. A systematic review of post-release programs for women exiting prison with substance-use disorders: assessing current programs and weighing the evidence. HEALTH & JUSTICE 2022; 10:1. [PMID: 34978645 PMCID: PMC8725487 DOI: 10.1186/s40352-021-00162-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/04/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND The rising rates of women in prison is a serious public health issue. Unlike men, women in prison are characterised by significant histories of trauma, poor mental health, and high rates of substance use disorders (SUDs). Recidivism rates of women have also increased exponentially in the last decade, with substance related offences being the most imprisoned offence worldwide. There is a lack of evidence of the effectiveness of post-release programs for women. The aim of this systematic review is to synthesise and evaluate the evidence on post-release programs for women exiting prison with SUDs. METHODS We searched eight scientific databases for empirical original research published in English with no date limitation. Studies with an objective to reduce recidivism for adult women (⩾18 years) with a SUD were included. Study quality was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB2) and the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tools. RESULTS Of the 1493 articles, twelve (n = 3799 women) met the inclusion criteria. Recidivism was significantly reduced in five (42%) programs and substance-use was significantly reduced in one (8.3%) program. Common attributes among programs that reduced recidivism were: transitional, gender-responsive programs; provision of individualised support; providing substance-related therapy, mental health and trauma treatment services. Methodological and reporting biases were common, which impacted our ability to synthesize results further. Recidivism was inconsistently measured across studies further impacting the ability to compare results across studies. CONCLUSIONS Recidivism is a problematic measure of program efficacy because it is inconsistently measured and deficit-focused, unrecognising of women's gains in the post-release period despite lack of tailored programs and significant health and social disadvantages. The current evidence suggests that women benefit from continuity of care from prison to the community, which incorporated gender-responsive programming and individualised case management that targeted co-morbid mental health and SUDs. Future program design should incorporate these attributes of successful programs identified in this review to better address the unique challenges that women with SUDs face when they transition back into the community.
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Affiliation(s)
- Layla Edwards
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Sacha Kendall Jamieson
- Sydney School of Education and Social Work, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Public Health, Australian Centre for Public and Population Health Research, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Julia Bowman
- Research Operations Manager, Research Unit, Justice Health and Forensic Mental Health Network, Malabar, NSW, 2036, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia
- School of Public Health, Australian Centre for Public and Population Health Research, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Sungwon Chang
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - Josie Newton
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Elizabeth Sullivan
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
- Acting Deputy Vice Chancellor Research, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Custodial Health Justice Health and Forensic Mental Health Network, Malabar, NSW, 2036, Australia.
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Breuer E, Remond M, Lighton S, Passalaqua J, Galouzis J, Stewart KA, Sullivan E. The needs and experiences of mothers while in prison and post-release: a rapid review and thematic synthesis. HEALTH & JUSTICE 2021; 9:31. [PMID: 34773158 PMCID: PMC8590213 DOI: 10.1186/s40352-021-00153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/31/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND Women in prison are a vulnerable group, often with a history of abuse, out-of-home care, mental health problems and unemployment. Many are mothers when they become involved in the criminal justice system and their gender and parenting related needs are often not considered. The aim of this rapid review was to thematically synthesize the existing research on the needs and experiences of mothers while in, and following release from, prison in Australia. METHODS We conducted a rapid systematic search of electronic databases, search engines, the websites of key agencies, and contacted key agencies and researchers. RESULTS Twenty-two publications from 12 studies met the inclusion criteria and were thematically synthesized in relation to the mothers, their children, family and community, and systems and services which mothers had contact with. We found that mothers in prison have a history of disadvantage which is perpetuated by the trauma of imprisonment. Release from prison is a particularly challenging time for mothers. In relation to their children, the included studies showed that the imprisonment of mothers impacts their maternal identity and role and disrupts the mother-child relationship. Specific strategies are needed to maintain the mother-child relationship, and to ensure the needs and rights of the child are met. In relation to family and community, we found that although family and social support is an important need of women in prison, such support may not be available. Moreover, the stigma associated with having been in prison is a significant barrier to transitions into the community, including finding employment and housing. In relation to systems and services, although limited services exist to support women in prison and on release, these often do not consider the parenting role. Evaluations of parenting programs in prison found them to be acceptable and beneficial to participants but barriers to access limit the number of women who can participate. CONCLUSION Mothers have gender- and parenting-specific needs which should be considered in planning for corrective services in Australia. Any service redesign must place the woman and her children at the centre of the service.
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Affiliation(s)
- Erica Breuer
- College of Health, Medicine and Wellbeing, University of Newcastle, Level 4 West, Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
| | - Marc Remond
- College of Health, Medicine and Wellbeing, University of Newcastle, Level 4 West, Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| | | | - Jane Passalaqua
- College of Health, Medicine and Wellbeing, University of Newcastle, Level 4 West, Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| | | | | | - Elizabeth Sullivan
- College of Health, Medicine and Wellbeing, University of Newcastle, Level 4 West, Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
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14
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Jennings L, Branson CF, Maxwell AM, Winkelman TNA, Shlafer RJ. Physicians' perspectives on continuity of care for patients involved in the criminal justice system: A qualitative study. PLoS One 2021; 16:e0254578. [PMID: 34260620 PMCID: PMC8279398 DOI: 10.1371/journal.pone.0254578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2016, over 11 million individuals were admitted to prisons and jails in the United States. Because the majority of these individuals will return to the community, addressing their health needs requires coordination between community and correctional health care providers. However, few systems exist to facilitate this process and little is known about how physicians perceive and manage these transitions. OBJECTIVE The goal of this study was to characterize physicians' views on transitions both into and out of incarceration and describe how knowledge of a patient's criminal justice involvement impacts patient care plans. METHODS Semi-structured interviews were conducted between October 2018 and May 2019 with physicians from three community clinics in Hennepin County, Minnesota. Team members used a hybrid approach of deductive and inductive coding, in which a priori codes were defined based on the interview guide while also allowing for data-driven codes to emerge. RESULTS Four themes emerged related to physicians' perceptions on continuity of care for patients with criminal justice involvement. Physicians identified disruptions in patient-physician relationships, barriers to accessing prescription medications, disruptions in insurance coverage, and problems with sharing medical records, as factors contributing to discontinuity of care for patients entering and exiting incarceration. These factors impacted patients differently depending on the direction of the transition. CONCLUSIONS Our findings identified four disruptions to continuity of care that physicians viewed as key barriers to successful transitions into and out of incarceration. These disruptions are unlikely to be effectively addressed at the provider level and will require system-level changes, which Medicaid and managed care organizations could play a leading role in developing.
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Affiliation(s)
- Latasha Jennings
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States of America
| | - Carolina Fernández Branson
- School of Communication, Writing and the Arts, Department of Professional Communication, Metropolitan State University, Saint Paul, MN, United States of America
| | - Andrea M. Maxwell
- Medical Scientist Training Program, Medical School, University of Minnesota, Minneapolis, MN, United States of America
| | - Tyler N. A. Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States of America
- General Internal Medicine, Department of Medicine, University of Minnesota and Hennepin Healthcare, Minneapolis, MN, United States of America
| | - Rebecca J. Shlafer
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, United States of America
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Gentile G, Nicolazzo M, Bianchi R, Bailo P, Boracchi M, Tambuzzi S, Zoja R. Mortality in Prisons: The Experience of the Bureau of Legal Medicine of Milan (Italy) (1993-2017) : Suicides and natural deaths in prison. MEDICINE, SCIENCE, AND THE LAW 2021; 61:67-76. [PMID: 33591876 DOI: 10.1177/0025802420934266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We undertook a retrospective analysis of deaths that took place in prisons in Milan between 1993 and 2017, by identifying cases from a total of 24,101 autopsies that were performed at the Section of Forensic Medicine of the University of Milan. From the archives of this institution, we found 227 autopsy reports relating to deaths that had taken place in one of Milan's three detention facilities. These deaths were divided into two types: natural deaths (n=135; 59.5%) and violent deaths (n=92; 40.5%). The groups have different characteristics: while natural deaths mostly resulted from cardiovascular diseases, suicides were mainly the result of hanging. Further, people who died by suicide often had a history of psychiatric disease and/or drug abuse, and over a quarter of them had previous suicide attempts and/or had declared suicidal intentions. This study confirms the need for good quality healthcare services for prisoners, given that they remain a population at high risk of early death.
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Affiliation(s)
- Guendalina Gentile
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Marta Nicolazzo
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Rachele Bianchi
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Paolo Bailo
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Michele Boracchi
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Stefano Tambuzzi
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
| | - Riccardo Zoja
- Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni - Università degli Studi di Milano, Italy
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Hu C, Jurgutis J, Edwards D, O’Shea T, Regenstreif L, Bodkin C, Amster E, Kouyoumdjian FG. "When you first walk out the gates…where do [you] go?": Barriers and opportunities to achieving continuity of health care at the time of release from a provincial jail in Ontario. PLoS One 2020; 15:e0231211. [PMID: 32275680 PMCID: PMC7147766 DOI: 10.1371/journal.pone.0231211] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/18/2020] [Indexed: 12/16/2022] Open
Abstract
We aimed to explore continuity of health care and health barriers, facilitators, and opportunities for people at the time of release from a provincial correctional facility in Ontario, Canada. We conducted focus groups in community-based organizations in a city in Ontario, Canada: a men’s homeless shelter, a mental health service organization, and a social service agency with programs for people with substance use disorders. We included adults who spoke English well enough to participate in the discussion and who had been released from the provincial correctional facility in the previous year. We conducted three focus groups with 18 total participants. Participants had complex health needs on release, including ongoing physical and psychological impacts of time in custody. They identified lack of access to high quality health care; lack of housing, employment, social services, and social supports; and discrimination on the basis of incarceration history as barriers to health on release. Access to health care, housing, social services, and social supports all facilitated health on release. To address health needs on release, participants suggested providing health information in jail, improving discharge planning, and developing accessible clinics in the community. This pilot study identified opportunities to support health at the time of release from jail, including delivery of programs in jail, linkage with and development of programs in the community, and efforts to support structural changes to prevent and address discrimination. These data will inform ongoing work to support health and continuity of care on release from a provincial correctional facility.
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Affiliation(s)
| | - Jessica Jurgutis
- McMaster University, Hamilton, Ontario, Canada
- Lakehead University, Thunder Bay, Ontario, Canada
| | - Dan Edwards
- McMaster University, Hamilton, Ontario, Canada
| | - Tim O’Shea
- McMaster University, Hamilton, Ontario, Canada
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18
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Smith SA, Mays GP, Collins TC, Ramaswamy M. The role of the community health delivery system in the health and well-being of justice-involved women: a narrative review. HEALTH & JUSTICE 2019; 7:12. [PMID: 31254119 PMCID: PMC6717968 DOI: 10.1186/s40352-019-0092-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/17/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Over seven million imprisoned and jailed women are released into the community each year and many are ill-equipped to meet the challenges of re-integration. Upon release into their community, women are faced with uncertain barriers and challenges using community services to improve their health and well-being and reuniting with families. Few studies have identified and described the barriers of the community health delivery system (CHDS)- a complex set of social, justice, and healthcare organizations that provide community services aimed to improve the health and well-being (i.e. safety, health, the success of integration, and life satisfaction) of justice-involved women. We conducted a narrative review of peer-reviewed and gray literature to identify and describe the CHDS and the CHDS service delivery. RESULTS Peer-reviewed and gray literature (n = 82) describing the CHDS organizations' missions, incentives, goals, and services were coded in three domains, justice, social, and healthcare, to examine their service delivery to justice-involved women and their efforts to improve the health and well-being of justice-involved women. CONCLUSIONS We found that the CHDS is fragmented, identified gaps in knowledge about the CHDS that serves justice-involved women, and offer recommendations to reduce fragmentation and integrate service delivery aimed to improve the health and well-being of justice-involved women.
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Affiliation(s)
- Sharla A. Smith
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, 1010 N. Kansas Street, Wichita, KS 67214 USA
| | - Glen P. Mays
- Department of Health Management & Policy, College of Public Health, The University of Kentucky, 111 Washington Avenue #201, Lexington, KY 40536-0003 USA
| | - Tracie C. Collins
- Department of Preventive Medicine & Public Health, University of Kansas School of Medicine, 1010 N. Kansas St., Ste 1406, Wichita, KS 67214-3199 USA
| | - Megha Ramaswamy
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1008, Kansas City, KS 66160 USA
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Brooker R, Hu W, Reath J, Abbott P. Medical student experiences in prison health services and social cognitive career choice: a qualitative study. BMC MEDICAL EDUCATION 2018; 18:3. [PMID: 29291725 PMCID: PMC5748951 DOI: 10.1186/s12909-017-1109-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 12/17/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND One of the purposes of undergraduate medical education is to assist students to consider their future career paths in medicine, alongside the needs of the societies in which they will serve. Amongst the most medically underserved groups of society are people in prison and those with a history of incarceration. In this study we examined the experiences of medical students undertaking General Practice placements in a prison health service. We used the theoretical framework of the Social Cognitive Career Theory (SCCT) to explore the potential of these placements to influence the career choices of medical students. METHODS Questionnaire and interview data were collected from final year students, comprising pre and post placement questionnaire free text responses and post placement semi-structured interviews. Data were analysed using inductive thematic analysis, with reference to concepts from the SCCT Interest Model to further develop the findings. RESULTS Clinical education delivered in a prison setting can provide learning that includes exposure to a wide variety of physical and mental health conditions and also has the potential to stimulate career interest in an under-served area. While students identified many challenges in the work of a prison doctor, increased confidence (SCCT- Self-Efficacy) occurred through performance success within challenging consultations and growth in a professional approach to prisoners and people with a history of incarceration. Positive expectations (SCCT- Outcome Expectations) of fulfilling personal values and social justice aims and of achieving public health outcomes, and a greater awareness of work as a prison doctor, including stereotype rejection, promoted student interest in working with people in contact with the criminal justice system. CONCLUSION Placements in prison health services can stimulate student interest in working with prisoners and ex-prisoners by either consolidating pre-existing interest or expanding interest into a field they had not previously considered. An important aspect of such learning is the opportunity to overcome negative preconceptions of consultations with prisoners.
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Affiliation(s)
- Ron Brooker
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Penelope Abbott
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Medical homelessness and candidacy: women transiting between prison and community health care. Int J Equity Health 2017; 16:130. [PMID: 28728555 PMCID: PMC5520372 DOI: 10.1186/s12939-017-0627-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Women in contact with the prison system have high health needs. Short periods in prison and serial incarcerations are common. Examination of their experiences of health care both in prison and in the community may assist in better supporting their wellbeing and, ultimately, decrease their risk of returning to prison. Methods We interviewed women in prisons in Sydney, Australia, using pre-release and post-release interviews. We undertook thematic analysis of the combined interviews, considering them as continuing narratives of their healthcare experiences. We further reviewed the findings using the theoretical lens of candidacy to generate additional insights on healthcare access. Results Sixty-nine interviews were conducted with 40 women pre-release and 29 of these post-release. Most had histories of substance misuse. Women saw prison as an opportunity to address neglected health problems, but long waiting lists impeded healthcare delivery. Both in prison and in the community, the dual stigmas of substance misuse and being a prisoner could lead to provider judgements that their claims to care were not legitimate. They feared they would be blocked from care even if seriously ill. Family support, self-efficacy, assertiveness, overcoming substance misuse, compliance with health system rules and transitional care programs increased their personal capacity to access health care. Conclusions For women in transition between prison and community, healthcare access could be experienced as ‘medical homelessness’ in which women felt caught in a perpetual state of waiting and exclusion during cycles of prison- and community-based care. Their healthcare experiences were characterized by ineffectual attempts to access care, transient relationships with healthcare providers, disrupted medical management and a fear that stigma would prevent candidacy to health care even in the event of serious illness. Consideration of the vulnerabilities and likely points of exclusion for women in contact with the criminal justice system will assist in increasing healthcare access for this marginalised population.
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