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Peiper LJ, Cramer RJ, Cacace SC, Peters A, Corral AR, Post AF, Prowten SD, Moxie J. Development and implementation of a self-directed violence prevention training program for correctional behavioral health providers: a clinical trial study protocol. Pilot Feasibility Stud 2024; 10:107. [PMID: 39118161 PMCID: PMC11308153 DOI: 10.1186/s40814-024-01533-0] [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: 04/16/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Self-directed violence (SDV) comprises both suicide and self-injury and represents a pressing problem among incarcerated persons. Negative impacts of SDV in correctional settings also extend to behavioral health clinicians (BHCs) (e.g., job turnover). Correctional SDV risk assessment and management standards include staff training as part of the comprehensive approach. The Core Competency Model for Corrections (CCM-C) is a novel, evidence-informed training program for BHCs covering both clinician self-management and clinical care skills. METHODS This pilot trial is a type 3 hybrid implementation-effectiveness approach. It will employ a wait-list control sequential cross-over design. Participants (N = 50-100) will be BHCs employed by the North Carolina Department of Adult Corrections. Following stratification for years of clinical experience, BHCs will be randomly assigned to (1) a training group that receives CCM-C immediately and (2) a wait-list control receiving CCM-C approximately 6 weeks later. Electronically administrated survey evaluation will occur across baseline and two follow-up (i.e., 2 weeks after each training session) time points. DISCUSSION The primary outcome is feasibility assessed through collaboration with a Corrections Advisory Panel and feedback from BHCs. Secondary effectiveness outcomes that will be evaluated over time include SDV-related knowledge, attitudes, stigma, and intent to use training content. We will examine a tertiary outcome, namely compassion fatigue. Clinical trial limitations and impacts are discussed. TRIAL REGISTRATION Clinicaltrials.gov, NCT06359574. This study was registered on 04/05/2024.
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Affiliation(s)
- Lewis J Peiper
- NC Department of Adult Correction, 831 W. Morgan Street, Raleigh, NC, 27699, USA
| | - Robert J Cramer
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA.
| | - Sam C Cacace
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA
| | - Ava Peters
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA
| | - Adria R Corral
- NC Department of Adult Correction, 831 W. Morgan Street, Raleigh, NC, 27699, USA
| | - Abigail F Post
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA
| | - Skyler D Prowten
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA
| | - Jessamyn Moxie
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA
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Cramer RJ, Cacace S, Coffey A, Hazlett E, Kaniuka AR, Robertson R, Peiper LJ. Latent profiles and psychosocial correlates of persistent self-injury among incarcerated adults. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 93:101967. [PMID: 38401176 DOI: 10.1016/j.ijlp.2024.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/07/2024] [Accepted: 02/17/2024] [Indexed: 02/26/2024]
Abstract
Self-directed violence (SDV), including both suicide and non-suicidal self-injury, represents a major challenge for carceral systems. Persistent self-injury (PSI) is an understudied SDV subtype, especially within the carceral context. The present study addressed three research questions: (a) do naturally occurring SDV subgroups occur within a carceral population (e.g., PSI versus other classes); (b) how SDV groups may be differentiated by verbal or behavioral SDV; and (c) whether demographic, mental health, and incarceration-related factors are associated with SDV subgroups. We conducted a secondary analysis of existing data from a statewide carceral electronic medical record (N = 3527). Latent class analysis supports two SDV subtypes: episodic and persistent self-injury. The PSI class was characterized by significantly greater verbal expressions and behavioral acts of SDV compared to the episodic group. Correlates of the PSI subtype included older age, male sex, prior SDV, and lower depressive symptoms. Findings are discussed with respect to the proposed Diagnostic and Statistical Manual self-injury focused disorder, influential factors on SDV in carceral settings, and recommendations for future research and practice.
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Affiliation(s)
- Robert J Cramer
- Department of Public Health Sciences, UNC Charlotte, 19201 University City Blvd., Charlotte, NC 28223, USA.
| | - Sam Cacace
- Department of Public Health Sciences, UNC Charlotte, 19201 University City Blvd., Charlotte, NC 28223, USA
| | - Abby Coffey
- NC Division of Public Health, 5605 Six Forks Rd., Raleigh, NC 27609, USA
| | - Emily Hazlett
- Office of Scientific Integrity, Duke University, Durham, NC 27708, USA
| | - Andréa R Kaniuka
- Department of Public Health Sciences, UNC Charlotte, 19201 University City Blvd., Charlotte, NC 28223, USA
| | - Ryan Robertson
- Department of Public Health Sciences, UNC Charlotte, 19201 University City Blvd., Charlotte, NC 28223, USA
| | - Lewis J Peiper
- NC Department of Adult Correction, 831 W. Morgan Street, Raleigh, NC 27699, USA
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Rosenberg A, Puglisi LB, Thomas KA, Halberstam AA, Martin RA, Brinkley-Rubinstein L, Wang EA. "It's just us sitting there for 23 hours like we done something wrong": Isolation, incarceration, and the COVID-19 pandemic. PLoS One 2024; 19:e0297518. [PMID: 38354166 PMCID: PMC10866499 DOI: 10.1371/journal.pone.0297518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/05/2024] [Indexed: 02/16/2024] Open
Abstract
For the millions of people incarcerated in United States' prisons and jails during the COVID-19 pandemic, isolation took many forms, including medical isolation for those sick with COVID-19, quarantine for those potentially exposed, and prolonged facility-wide lockdowns. Incarcerated people's lived experience of isolation during the pandemic has largely gone undocumented. Through interviews with 48 incarcerated people and 27 staff at two jails and one prison in geographically diverse locations in the United States, we document the implementation of COVID-19 isolation policies from the perspective of those that live and work in carceral settings. Incarcerated people were isolated from social contact, educational programs, employment, and recreation, and lacked clear communication about COVID-19-related protocols. Being isolated, no matter the reason, felt like punishment and was compared to solitary confinement-with resultant long-term, negative impacts on health. Participants detailed isolation policies as disruptive, detrimental to mental health, and dehumanizing for incarcerated people. Findings point to several recommendations for isolation policy in carceral settings. These include integrating healthcare delivery into isolation protocols, preserving social relationships during isolation, promoting bidirectional communication about protocols and their effect between facility leadership and incarcerated people. Most importantly, there is an urgent need to re-evaluate the current approach to the use of isolation in carceral settings and to establish external oversight procedures for its use during pandemics.
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Affiliation(s)
- Alana Rosenberg
- SEICHE Center for Health and Justice, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Lisa B Puglisi
- SEICHE Center for Health and Justice, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Kathryn A Thomas
- SEICHE Center for Health and Justice, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Alexandra A Halberstam
- SEICHE Center for Health and Justice, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Rosemarie A Martin
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Lauren Brinkley-Rubinstein
- Department of Population Health Sciences and the Samuel Dubois Cook Center on Social Equity, Duke University, Durham, North Carolina, United States of America
| | - Emily A Wang
- SEICHE Center for Health and Justice, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Carter TJ, Whittle TN. The impact of correctional officer gender on prison suicide. HEALTH & JUSTICE 2023; 11:10. [PMID: 36809475 PMCID: PMC9942378 DOI: 10.1186/s40352-023-00214-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Correctional officers are critical members of the prison community. However, scholarship rarely considers how correctional officers contribute to prison outcomes instead largely focusing on importation (individual) and deprivation (organizational) factors related to the incarcerated population. This is also true regarding how scholars and practitioners approach suicide committed by incarcerated people, one of the leading causes of death in US carceral institutions. Using quantitative data from confinement facilities across the United States, this study answers the research question: What is the relationship between prison suicide rates and correctional officer gender? Results show that deprivation factors (variables related to the carceral environment) influence prison suicide. Additionally, gender diversity among correctional officers reduces the rate of prison suicide. Implications for future research and practice and limitations of the study are also discussed.
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Affiliation(s)
- TaLisa J Carter
- Department of Justice, Law, and Criminology, American University, Massachusetts Avenue, NW Washington, DC, 20016, USA.
| | - Tanya N Whittle
- Department of Sociology and Criminal Justice, Delaware State University, Dover, USA
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Kendig NE, Butkus R, Mathew S, Hilden D. Health Care During Incarceration: A Policy Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1742-1745. [PMID: 36410006 DOI: 10.7326/m22-2370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The American College of Physicians (ACP) has a long-standing commitment to improving the health of all Americans and opposes any form of discrimination in the delivery of health care services. ACP is committed to working toward fully understanding and supporting the unique needs of the incarcerated population and eliminating health disparities for these persons. In this position paper, ACP offers recommendations to policymakers and administrators to improve the health and well-being of persons incarcerated in adult correctional facilities.
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Affiliation(s)
- Newton E Kendig
- School of Medicine and Health Sciences, George Washington University, Washington, DC (N.E.K.)
| | - Renee Butkus
- American College of Physicians, Washington, DC (R.B.)
| | - Suja Mathew
- Atlantic Health System, Morristown, New Jersey (S.M.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
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The Relationship Between Age at Incarceration and Lifetime Suicide Attempt Among a Nationally Representative Sample of U.S. Adults. Community Ment Health J 2022; 58:1403-1415. [PMID: 35247109 DOI: 10.1007/s10597-022-00952-8] [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] [Received: 02/21/2021] [Accepted: 02/05/2022] [Indexed: 11/03/2022]
Abstract
To examine the association between age at incarceration and lifetime suicide attempt (SA), and whether it differs by gender. Lifetime prevalence of SA was compared between respondents with no incarceration, juvenile, and adult incarceration who completed the 2012-2013 National Survey of Alcohol and Related Conditions-III (N = 36,107). We compared the odds of SA, adjusting for sociodemographic characteristics, psychiatric disorders, and childhood adverse experiences, and stratified the results by gender. Adjusted odds ratio (AOR) of SA relative to no incarceration history was 1.66 (95% Confidence Interval [CI] 1.32-2.07) for adult incarceration and 2.00 (95% CI 1.49-2.70) for juvenile incarceration. AOR of SA relative to no incarceration history was 2.14 (95% CI 1.56-2.93) for adult and 2.15 (95% CI 1.38-3.35) for juvenile incarceration in women; it was 1.73 (95% CI 1.14-2.60) in juvenile incarceration relative to no incarceration history in men. A history of incarceration may increase SA, particularly among juvenile and women offenders.
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Holliday R, Desai A, Clem MA, Wortzel HS. Forensic Mental Health Assessment as a Critical Intercept for Enhancing Mental Health Care. J Psychiatr Pract 2022; 28:396-403. [PMID: 36074109 DOI: 10.1097/pra.0000000000000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Rates of psychiatric diagnosis, medical morbidity, and suicide risk are notably high among incarcerated individuals. However, engaging these individuals in community-based health care settings can be a challenge. Among justice-involved individuals who do access services, community-based health care settings may lack available resources to effectively conduct comprehensive assessments that inform evidence-based conceptualization. We propose forensic mental health assessment (FMHA) as a critical opportunity to enhance service delivery for this at-risk population. In particular, within the scope of their role, forensic mental health evaluators are able to conduct a comprehensive review of records across health (eg, inpatient and outpatient health care settings), social (eg, homeless shelter), and correctional (eg, jail or prison) settings. Moreover, FMHA often includes specialized batteries that are able to assess and differentially diagnose myriad clinical presentations that may have overlapping symptomatology. We present 2 case vignettes to illustrate the utility of FMHA for enhancing service delivery. Finally, we conclude by noting challenges to integrating FMHA into conceptualization and necessary next steps in research and programing.
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Comartin EB, Milanovic E, Nelson V, Kubiak S. Mental Health Identification Practices of Jails: The Unmet Needs of the "Silent" Population: Special Issue: Criminal Justice and Community Psychology: Our Values and Our Work. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 67:7-20. [PMID: 33009671 DOI: 10.1002/ajcp.12466] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The overrepresentation of individuals with mental illness in the criminal/legal system is well documented. While professional associations urge diversion towards treatment, little is known about the practices these institutions use to identify this population. One understudied space in the criminal/legal continuum is jails. This exploratory study compares two types of mental health identification at jail booking to assess jail- and community-based service outcomes by identification type (N = 2956): (a) staff observation and (b) a standardized screening instrument. Individuals identified through staff observation were significantly more likely to receive jail- and community-based services, even though current symptomology and substance misuse were both significantly higher for individuals identified only by the screening instrument. These findings point to the importance of jails in providing stabilizing services during incarceration, but further, show the impact that identification practices have on individuals as they transition to the community. Community context showed varied rates of jail staff observations of mental illness, showing greater risks for individuals in rural communities. Implications include a need for system-level changes by instituting evidence-based identification practices in jails, and improving professional collaboration practices between mental health and criminal/legal practitioners as individuals enter and exit jails.
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Affiliation(s)
- Erin B Comartin
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, USA
| | - Edita Milanovic
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, USA
| | - Victoria Nelson
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, USA
| | - Sheryl Kubiak
- Center for Behavioral Health and Justice, School of Social Work, Wayne State University, Detroit, MI, USA
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Abstract
This chapter presents a narrative synthesis of the evidence relating to the effectiveness of 13 different approaches (interventions) that have been incorporated into national suicide prevention programs. These approaches are presented in an analytic framework that distinguishes between national and community-based multilevel programs, prevention, and treatment/maintenance. The primary source of evidence are six reviews of reviews published since 2005, supplemented by a small number of systematic reviews and primary studies. We report strongly supportive evidence concerning the effectiveness of structural interventions (restrictions on access to bridges, tall buildings, and railways) and restriction on access to pharmacological agents. Weakly supportive evidence of effectiveness is available for community-based multilevel programs; restrictions on access to firearms and ligature points in institutional settings; settings-based programs (in schools, communities, workplaces, prisons, and the armed forces); education and training targeted at primary care physicians; lithium; cognitive behavioral therapy and dialectical behavioral therapy; and brief contact. There is insufficient or conflicting evidence concerning the effectiveness of the remaining approaches. We conclude that the evidence base for effective suicide prevention is far from convincing. Major improvement in the extent and quality of collaboration between researchers, policymakers, and practitioners and a considerable increase in funding for evaluation studies in suicide prevention are required if the current knowledge gap about effective interventions is to be bridged.
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Dixon KJ, Ertl AM, Leavitt RA, Sheats KJ, Fowler KA, Jack SPD. Suicides Among Incarcerated Persons in 18 U.S. States: Findings From the National Violent Death Reporting System, 2003-2014. JOURNAL OF CORRECTIONAL HEALTH CARE 2020; 26:279-291. [PMID: 32734839 DOI: 10.1177/1078345820939512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Using data from the National Violent Death Reporting System (2003-2014), this study examined the characteristics and contributing circumstances of suicides in correctional facilities. χ2 and logistic regression analyses revealed that, compared to nonincarcerated suicide decedents, incarcerated suicide decedents had significantly lower odds of positive toxicology for substances but significantly higher odds of substance abuse problems. Descriptive subanalyses indicated that incarcerated suicide decedents often were incarcerated for personal crimes. They often died ≤ 1 week of incarceration, in a cell (frequently single-person or segregation), by hanging, using bedding material. Positive toxicology was more common for incarcerated decedents who died shortly after versus later in their incarceration. Findings highlight the need for enhanced detection and treatment of suicidal behavior, especially during early and vulnerable periods of incarceration.
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Affiliation(s)
- Kristiana J Dixon
- Division of Violence Prevention, National Center for Injury Prevention and Control, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Allison M Ertl
- Division of Violence Prevention, National Center for Injury Prevention and Control, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel A Leavitt
- Division of Violence Prevention, National Center for Injury Prevention and Control, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kameron J Sheats
- Division of Violence Prevention, National Center for Injury Prevention and Control, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine A Fowler
- Division of Violence Prevention, National Center for Injury Prevention and Control, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shane P D Jack
- Division of Violence Prevention, National Center for Injury Prevention and Control, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
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