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Zielinski MJ, Allison MK, Smith MKS, Curran G, Kaysen D, Kirchner JE. Implementation of group cognitive processing therapy in correction centers: Anticipated determinants from formative evaluation. J Trauma Stress 2023; 36:193-204. [PMID: 36468175 PMCID: PMC10069158 DOI: 10.1002/jts.22898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 12/07/2022]
Abstract
Nearly all people in prison have experienced trauma, and many meet the criteria for posttraumatic stress disorder (PTSD). Untreated PTSD increases the risk of substance use problems after release, contributing to a well-documented cycle of trauma, addiction, and incarceration. However, evidence-based, trauma-focused therapy for PTSD is rarely offered in prisons, and there is little research that can guide implementation efforts. In preparation for an effectiveness-implementation hybrid II pilot trial examining group-delivered cognitive processing therapy (CPT) in prisons, we conducted a formative evaluation using interviews structured according to the consolidated framework for implementation research (i.e., CFIR). Participants were correction center leadership, treatment staff, health care staff, and security staff (n = 22) and incarcerated persons (n = 14; 57.1% female). We found that CPT was highly compatible with residents' needs and the centers' available resources, culture, existing programs, and current workflow. CPT was also acceptable to all stakeholders. Potential barriers were the lower relative priority for CPT compared with programs that are reinforced at the system level, limited staff time to deliver CPT, limited staff knowledge about PTSD, and center features that could distract from CPT groups and/or training or be countertherapeutic. Taken together, CPT is a promising trauma-focused therapy for corrections, but these findings underscore the importance of identifying and matching potential barriers to effective implementation strategies a priori and work in the policy arena to promote sustainability.
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Affiliation(s)
- Melissa J. Zielinski
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | - M. Kathryn Allison
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mollee K. Steely Smith
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Geoffrey Curran
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - JoAnn E. Kirchner
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
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Mansour Y, Emerson A, Lipnicky A, Lorvick J, Comfort M, Mildrum Chana S, Ramaswamy M. Cervical Cancer Risk and Prevention Practices Among Sexual Minority Women with Criminal-Legal System Involvement. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2022; 3:98-110. [PMID: 37727363 PMCID: PMC10508889 DOI: 10.1891/lgbtq-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Women with criminal-legal system involvement bear a disproportionate burden of cervical cancer, indeed 4-5 times more than women without criminal-legal system involvement. While we also know that sexual minority identification (lesbian/gay, queer, bisexual, or not straight) is more common among women with criminal-legal system involvement, we lack understanding of the cervical cancer risk and prevention practices of this group of women. In 2019-2020, we used surveys to investigate cervical cancer risk and prevention practices among 510 women with criminal-legal system involvement in Kansas City (KS and MO), Oakland (CA), and Birmingham (AL). In a secondary data analysis, we compared sexual minority women (SMW defined as women who identified as lesbian/gay, bisexual, or other -19% of the sample) to women who identified as heterosexual or straight - 81% of sample). SMW were less likely to have ever gotten a cervical cancer screening test, compared to straight women. Having a provider whom women felt they could rely on was associated with having an up-to-date cervical cancer screening test among SMW. SMW with criminal-legal system involvement are missing out on necessary cancer screenings. Further study to understand why and interventions to ensure this group receives preventive care are needed to prevent cervical cancer and reduce disparities.
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Messina NP, Esparza P. Poking the bear: The inapplicability of the RNR principles for justice-involved women. J Subst Abuse Treat 2022; 140:108798. [DOI: 10.1016/j.jsat.2022.108798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/30/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
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Dueweke AR, Higuera DE, Zielinski MJ, Karlsson ME, Bridges AJ. Does Group Size Matter? Group Size and Symptom Reduction Among Incarcerated Women Receiving Psychotherapy Following Sexual Violence Victimization. Int J Group Psychother 2022; 72:1-33. [PMID: 36249160 PMCID: PMC9555233 DOI: 10.1080/00207284.2021.2015601] [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: 01/30/2023]
Abstract
Survivors Healing from Abuse: Recovery through Exposure (SHARE) is an eight-week therapy group for incarcerated women who have experienced sexual violence victimization. SHARE requires each member to complete an imaginal exposure and to listen when others share their experiences of victimization. While trauma-focused group interventions including SHARE are associated with reductions in internalizing symptoms, little work has examined how group characteristics predict symptom decreases. The purpose of this study was to examine whether group size was associated with symptom changes pre- to post-treatment. Participants (n=140 across 29 groups) completed self-report measures of posttraumatic stress symptoms before and after completing SHARE. Multilevel modeling revealed the majority of the variance in post-treatment symptoms was attributed to individual factors rather than group factors. Symptom change was comparable for groups of two to eight women; declines in symptom improvement were observed at a group size of ten participants.
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Affiliation(s)
- Aubrey R. Dueweke
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA
| | - Danielle E. Higuera
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA
| | - Melissa J. Zielinski
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA.,Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Marie E. Karlsson
- Department of Psychology, Murray State University, 212 Wells Hall, Murray, KY 42071, USA
| | - Ana J. Bridges
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, USA
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Zielinski MJ, Karlsson ME, Bridges AJ. "I'm not alone, my story matters": Incarcerated women's perspectives on the impact and acceptability of group psychotherapy involving imaginal exposure to sexual assault memories. HEALTH & JUSTICE 2021; 9:25. [PMID: 34591180 PMCID: PMC8482612 DOI: 10.1186/s40352-021-00148-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/28/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Although it is clear that incarcerated women need access to effective therapies for trauma sequelae, some have argued that one of the most effective treatments - exposure therapy - should not be provided in carceral settings due to the presumed lack of safety and stability making such an intervention inappropriate. Group therapy, the typical mode of intervention in prisons, has also been presumed to be unacceptable for exposure-based processing due to assumptions that hearing others' trauma narratives would be traumatizing and unhelpful to listeners. However, there is a lack of data to support either of the aforementioned assumptions. This study examined the acceptability of an exposure-based group therapy for women survivors of sexual violence who were currently incarcerated (N = 61) by asking women themselves about their experiences completing an exposure-based group therapy protocol (SHARE; Survivors Healing from Abuse: Recovery through Exposure) while incarcerated. We assessed women's reasons for enrolling in the group, satisfaction with various therapy components (e.g., exposure, skill-building) and the treatment overall, and experiences of both sharing and listening to trauma narratives using a feedback survey that included a mix of multiple-choice and open-ended questions. Treatment dropout was examined as an additional index of acceptability. RESULTS Treatment completion was very high (88.8%). Nearly all women who completed the group reported that they would recommend it to other incarcerated women (96.7%, with the remaining 3.3% reporting "it depends"). Qualitative results revealed overwhelmingly positive feedback about the effect of the group and indicated that sharing and listening to trauma narratives in a group setting serve discrete but dually important functions. Specifically, women almost universally experienced listening to others' trauma narratives (i.e., exposures) in the SHARE group context as helpful-making them feel less alone and normalizing their experiences. Sharing one's own story primarily provided an emotional release and/or transformation (i.e., an intrapersonal rather than interpersonal function). CONCLUSIONS Our findings challenge common concerns about the appropriateness of 1) prison as a context for trauma-focused treatments, including exposure and 2) sharing trauma narratives in a group setting. Unless empirical evidence demonstrating harm is uncovered, best practices for PTSD and other trauma-related sequelae-those recommended in reputable treatment guidelines and interventions like SHARE that incorporate components shown to be effective (e.g., cognitive challenging, exposure)-should be offered to incarcerated women as part of standard of care.
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Affiliation(s)
- Melissa J Zielinski
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W. Markham Street Little Rock, Little Rock, AR, 72205, USA.
- Department of Psychological Sciences, University of Arkansas, AR, Fayetteville, USA.
| | - Marie E Karlsson
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Ana J Bridges
- Department of Psychological Sciences, University of Arkansas, AR, Fayetteville, USA
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Baker B. Mothering and Incarceration: A Conceptual Model Supporting Maternal Identity. JOURNAL OF CORRECTIONAL HEALTH CARE 2021; 27:103-110. [PMID: 34232783 DOI: 10.1089/jchc.20.04.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Current literature expounds on community and personal factors contributing to the rapidly growing number of women involved in the criminal justice system. Contributing factors are complex and interwoven, leaving women with life patterns of trauma exposure, mental illness, and substance use disorders. Consequences of these life patterns and incarceration have a significant impact on maternal role attainment. The conceptual model Mothering and Incarceration organizes the multifaceted life patterns of incarcerated women and the influences on a woman's ability to mother her children during and following incarceration. The model has the potential to provide direction to program developers, researchers, and correctional systems to tailor programs for women. The most significant implication of the conceptual model is ending the intergenerational influences of incarceration on children.
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Affiliation(s)
- Brenda Baker
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta Georgia, USA
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Emerson AM, Wickliffe J, Kelly PJ, Ramaswamy M. Feminism and Bourdieusian Social Theory in a Sexual Health Empowerment Project with Incarcerated and Recently Released Women. SOCIAL THEORY & HEALTH 2019; 17:57-74. [PMID: 30853856 PMCID: PMC6404768 DOI: 10.1057/s41285-018-0068-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Theory is often downplayed or omitted in the research and scholarly literature around public health interventions in carceral settings. Our Sexual Health Empowerment (SHE) project was an education intervention and ethnographic study that aimed to reduce cervical cancer risk among women with histories of incarceration. In this article, we describe our application of concepts from feminist theory and bourdieusian social theory to the design, planning, and delivery of SHE. We outline how theory-driven practice both underscored and helped us meet challenges in implementation in three urban jails over a two-year period, 2014-2016. Our approach provides a model for others who wish to bring critical theory and research practice together in health interventions with populations that are marginalized in multiple ways.
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Affiliation(s)
- Amanda M Emerson
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO 64108, 816-520-9004
| | - Joi Wickliffe
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Robinson 4004, Kansas City, KS 66160, 913-588-2646
| | - Patricia J Kelly
- (retired), School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO 64108, 816-235-2617
| | - Megha Ramaswamy
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Robinson 4004, Kansas City, KS 66160, 913-588-1053
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