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Robles-Ramamurthy B, Bath E, Lowenhaupt EA, Tolou-Shams M. Advancing Youth Justice: The Child and Adolescent Psychiatrist's Role. Child Adolesc Psychiatr Clin N Am 2024; 33:397-409. [PMID: 38823812 DOI: 10.1016/j.chc.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
Child and adolescent psychiatrists (CAPs) play a crucial role beyond the provision of clinical care. CAPs are uniquely placed to understand and help patients navigate the fine line among psychiatric care, health and well-being, and the laws and policies supporting or impairing these processes. Focusing on vulnerable populations, such as legal system impacted youth and families, CAPs can contribute to the ongoing development of a more just and equitable world for the children of today and of tomorrow.
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Affiliation(s)
- Barbara Robles-Ramamurthy
- Department Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 10004 Wurzbach Road, 283, San Antonio, TX 78230, USA.
| | - Eraka Bath
- Division of Child and Adolescent Psychiatry, UCLA Neuropsychiatric Institute, David Geffen School of Medicine
| | - Elizabeth A Lowenhaupt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy Street, POB-122, Providence, RI 02903, USA
| | - Marina Tolou-Shams
- San Francisco|Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Zuckerberg San Francisco General Hospital and Trauma Center, 1001 Potrero Avenue, Building 5, Room 7M18, San Francisco, CA 94110, USA
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2
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Haber LA, Sears D, Williams BA. Medicaid for Medical-Correctional Care: Time to Manage What is Reimbursed. J Gen Intern Med 2024:10.1007/s11606-024-08842-3. [PMID: 38831244 DOI: 10.1007/s11606-024-08842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Lawrence A Haber
- Division of Hospital Medicine, Denver Health and Hospital, Authority, Denver, CO, USA.
- Department of Medicine, University of Colorado, Aurora, CO, USA.
| | - David Sears
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Brie A Williams
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Lewis CD, Andrews C, Abraham AJ, Westlake M, Taxman FS, Grogan CM. State Medicaid Initiatives Targeting Substance Use Disorder in Criminal Legal Settings, 2021. Am J Public Health 2024; 114:527-530. [PMID: 38513172 PMCID: PMC11008297 DOI: 10.2105/ajph.2024.307604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Objectives. To document state Medicaid pre- and postrelease initiatives for individuals in the criminal legal system with substance use disorder (SUD). Methods. An Internet-based survey was sent in 2021 to Medicaid directors in all 50 US states and the District of Columbia to determine whether they were pursuing initiatives for persons with SUD across 3 criminal legal settings: jails, prisons, and community corrections. A 90% response rate was obtained. Results. In 2021, the majority of states did not report any targeted Medicaid initiatives for persons with SUD residing in criminal legal settings. Eighteen states and the District of Columbia adopted at least 1 Medicaid initiative for persons with SUD across the 3 criminal legal settings. The most commonly adopted initiatives were in the areas of medication for opioid use disorder treatment and Medicaid enrollment. Out of 24 possible initiatives for each state (8 initiatives across 3 criminal legal settings), the 2 most commonly adopted were (1) provision of medication treatment of opioid use disorder before release from criminal legal settings (16 states) and (2) facilitation of Medicaid enrollment through suspension rather than termination of Medicaid enrollment upon entry to a criminal legal setting (14 states). Initiatives pertaining to Medicaid SUD care coordination were adopted by the fewest (9) states. Conclusions. In 2021, states' involvement in Medicaid SUD initiatives for criminal legal populations remained low. Increased adoption of Medicaid SUD initiatives across criminal legal settings is needed, especially knowing the high rate of overdose mortality among this group. (Am J Public Health. 2024;114(5):527-530. https://doi.org/10.2105/AJPH.2024.307604).
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Affiliation(s)
- Cashell D Lewis
- Cashell D. Lewis is with Crown Family School of Social Work, Policy, and Practice, University of Chicago, IL. Christina Andrews and Melissa Westlake are with the Department of Health Services Policy and Management at Arnold School of Public Health, University of South Carolina, Columbia. Amanda J. Abraham is with the Department of Public Administration and Policy in the School of Public and International Affairs, University of Georgia, Athens. Faye S. Taxman is with the Schar School of Policy and Government and Center for Advancing Correctional Excellence!, George Mason University, Fairfax, VA. Colleen M. Grogan is with Crown Family School of Social Work, Policy, and Practice and the Center for Health Administration Studies, University of Chicago
| | - Christina Andrews
- Cashell D. Lewis is with Crown Family School of Social Work, Policy, and Practice, University of Chicago, IL. Christina Andrews and Melissa Westlake are with the Department of Health Services Policy and Management at Arnold School of Public Health, University of South Carolina, Columbia. Amanda J. Abraham is with the Department of Public Administration and Policy in the School of Public and International Affairs, University of Georgia, Athens. Faye S. Taxman is with the Schar School of Policy and Government and Center for Advancing Correctional Excellence!, George Mason University, Fairfax, VA. Colleen M. Grogan is with Crown Family School of Social Work, Policy, and Practice and the Center for Health Administration Studies, University of Chicago
| | - Amanda J Abraham
- Cashell D. Lewis is with Crown Family School of Social Work, Policy, and Practice, University of Chicago, IL. Christina Andrews and Melissa Westlake are with the Department of Health Services Policy and Management at Arnold School of Public Health, University of South Carolina, Columbia. Amanda J. Abraham is with the Department of Public Administration and Policy in the School of Public and International Affairs, University of Georgia, Athens. Faye S. Taxman is with the Schar School of Policy and Government and Center for Advancing Correctional Excellence!, George Mason University, Fairfax, VA. Colleen M. Grogan is with Crown Family School of Social Work, Policy, and Practice and the Center for Health Administration Studies, University of Chicago
| | - Melissa Westlake
- Cashell D. Lewis is with Crown Family School of Social Work, Policy, and Practice, University of Chicago, IL. Christina Andrews and Melissa Westlake are with the Department of Health Services Policy and Management at Arnold School of Public Health, University of South Carolina, Columbia. Amanda J. Abraham is with the Department of Public Administration and Policy in the School of Public and International Affairs, University of Georgia, Athens. Faye S. Taxman is with the Schar School of Policy and Government and Center for Advancing Correctional Excellence!, George Mason University, Fairfax, VA. Colleen M. Grogan is with Crown Family School of Social Work, Policy, and Practice and the Center for Health Administration Studies, University of Chicago
| | - Faye S Taxman
- Cashell D. Lewis is with Crown Family School of Social Work, Policy, and Practice, University of Chicago, IL. Christina Andrews and Melissa Westlake are with the Department of Health Services Policy and Management at Arnold School of Public Health, University of South Carolina, Columbia. Amanda J. Abraham is with the Department of Public Administration and Policy in the School of Public and International Affairs, University of Georgia, Athens. Faye S. Taxman is with the Schar School of Policy and Government and Center for Advancing Correctional Excellence!, George Mason University, Fairfax, VA. Colleen M. Grogan is with Crown Family School of Social Work, Policy, and Practice and the Center for Health Administration Studies, University of Chicago
| | - Colleen M Grogan
- Cashell D. Lewis is with Crown Family School of Social Work, Policy, and Practice, University of Chicago, IL. Christina Andrews and Melissa Westlake are with the Department of Health Services Policy and Management at Arnold School of Public Health, University of South Carolina, Columbia. Amanda J. Abraham is with the Department of Public Administration and Policy in the School of Public and International Affairs, University of Georgia, Athens. Faye S. Taxman is with the Schar School of Policy and Government and Center for Advancing Correctional Excellence!, George Mason University, Fairfax, VA. Colleen M. Grogan is with Crown Family School of Social Work, Policy, and Practice and the Center for Health Administration Studies, University of Chicago
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Wisniewski JM, Walker B, Patlola I, Sharma R, Tinkler S. Disparities in access to appointments for contraceptive services among Black, Hispanic, White, and recently incarcerated women in Alabama, Louisiana, and Mississippi. Health Serv Res 2024; 59:e14275. [PMID: 38233334 PMCID: PMC10915479 DOI: 10.1111/1475-6773.14275] [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] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To measure differences in access to contraceptive services based on history of incarceration and its intersections with race/ethnicity and insurance status. DATA SOURCES AND STUDY SETTING Primary data were collected from telephone calls to physician offices in Alabama, Louisiana, and Mississippi in 2021. STUDY DESIGN We deployed a field experiment. The outcome variables were appointment offers, wait days, and questions asked of the caller. The independent variables were callers' incarceration history, race/ethnicity, and insurance. DATA COLLECTION METHODS Using standardized scripts, Black, Hispanic, and White female research assistants called actively licensed primary care physicians and Obstetrician/Gynecologists asking for the next available appointment for a contraception prescription. Physicians were randomly selected and randomly assigned to callers. In half of calls, callers mentioned recent incarceration. We also varied insurance status. PRINCIPAL FINDINGS Appointment offer rates were five percentage points lower (95% CI: -0.10 to 0.01) for patients with a history of incarceration and 11 percentage points lower (95% CI: -0.15 to -0.06) for those with Medicaid. We did not find significant differences in appointment offer rates or wait days when incarceration status was interacted with race or insurance. Schedulers asked questions about insurance significantly more often to recently incarcerated Black patients and recently incarcerated patients who had Medicaid. CONCLUSIONS Women with a history of incarceration have less access to medical appointments; this access did not vary by race or insurance status among women with a history of incarceration.
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Affiliation(s)
- Janna M. Wisniewski
- Department of International Health and Sustainable DevelopmentTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
| | - Brigham Walker
- Department of Health Policy and ManagementTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
| | - Isha Patlola
- Newcomb‐Tulane College, Tulane UniversityNew OrleansLouisianaUSA
| | - Rajiv Sharma
- Department of EconomicsPortland State UniversityPortlandOregonUSA
| | - Sarah Tinkler
- Department of EconomicsPortland State UniversityPortlandOregonUSA
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Emerson A, Li X, Zaller N, Ramaswamy M. Characterizing Aging-Related Health in Older Women with a History of Incarceration: Multimorbidity, Polypharmacy, Mortality, Frailty, and Depression. J Aging Health 2024:8982643241233322. [PMID: 38374771 DOI: 10.1177/08982643241233322] [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] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To characterize aging-related health in women with past CLSI and compare with women with no-CLSI. METHOD Health and Retirement Study Wave 11 and 12 data from women age >50 with CLSI were compared with data from women age >50 with no-CLSI. Generalized linear models were estimated for aging-related health outcomes. RESULTS The group with CLSI (n = 230) was significantly younger than the no-CLSI group (n = 8035) yet had more physical, functional, and mental health challenges and fewer resources. Incarceration significantly predicted aging-related outcomes of multimorbidity, polypharmacy, mortality, frailty, and depression. DISCUSSION Earlier onset of physical and functional health conditions in women with past CLSI has implications for health education and promotion, clinical practice, and intervention design.
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Affiliation(s)
- Amanda Emerson
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Xinyang Li
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Nick Zaller
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
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Jindal M, Barnert E, Chomilo N, Gilpin Clark S, Cohen A, Crookes DM, Kershaw KN, Kozhimannil KB, Mistry KB, Shlafer RJ, Slopen N, Suglia SF, Nguemeni Tiako MJ, Heard-Garris N. Policy solutions to eliminate racial and ethnic child health disparities in the USA. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:159-174. [PMID: 38242598 PMCID: PMC11163982 DOI: 10.1016/s2352-4642(23)00262-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 01/21/2024]
Abstract
Societal systems act individually and in combination to create and perpetuate structural racism through both policies and practices at the local, state, and federal levels, which, in turn, generate racial and ethnic health disparities. Both current and historical policy approaches across multiple sectors-including housing, employment, health insurance, immigration, and criminal legal-have the potential to affect child health equity. Such policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. Policy efforts that do not directly address structural racism will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism. In Paper 2 of this Series, we build on Paper 1's summary of existing disparities in health-care delivery and highlight policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improve the health of racially and ethnically minoritised children.
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Affiliation(s)
- Monique Jindal
- Department of Medicine, University of Illinois Chicago School of Medicine, Chicago, IL, USA.
| | - Elizabeth Barnert
- Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Nathan Chomilo
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Shawnese Gilpin Clark
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alyssa Cohen
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Danielle M Crookes
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA; Department of Sociology and Anthropology, College of Social Sciences and Humanities, Northeastern University, Boston, MA, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katy Backes Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kamila B Mistry
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Office of Extramural Research, Education, and Priority Populations, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD, USA
| | - Rebecca J Shlafer
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA, USA; Center on the Developing Child, Harvard University, Boston, MA, USA
| | - Shakira F Suglia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Nia Heard-Garris
- Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Institute for Policy Research, Northwestern University, Chicago, IL, USA
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Rockey N, Cervantes L, LeMasters K, Rizzolo K. Challenging Health Inequities in Incarceration: a Call for Equitable Care for Kidney Disease and Hypertension. Curr Hypertens Rep 2023; 25:437-445. [PMID: 37773248 DOI: 10.1007/s11906-023-01267-z] [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] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE OF REVIEW To review the current literature on care of hypertension and chronic kidney disease for people who are currently and formerly incarcerated, and to make recommendations for improving outcomes. RECENT FINDINGS There is a growing body of literature describing care for kidney disease and hypertension for incarcerated and formerly incarcerated individuals that documents the provision of care itself, notably that many jails contract with private companies; the system is not designed to provide sustained, chronic disease care; and the transition from incarceration to community is fraught with gaps in care. However, deficiencies in data collection and regulation still limit our understanding of the quality of care provided in jails and prisons. Furthermore, more data is needed to understand the impact of structural racism in the criminal legal system on overall disparities in care for hypertension and kidney disease. Insurance coverage rates for people who were formerly incarcerated continue to be lower than the general population despite Medicaid expansion in many states. There is little recent data regarding kidney replacement therapy for this population despite known variation in dialysis modalities and transplant programs by state. Transitions clinics, which connect people who were formerly incarcerated with care in the community upon release, are growing and are important avenues by which to deliver care. People who are incarcerated are disproportionately affected by hypertension and kidney disease, yet data regarding the extent of these inequities and availability of quality care is lacking. More work is needed to understand the care of individuals with kidney disease and hypertension in prisons and to improve outcomes for these common chronic conditions. Both providing effective treatment of kidney disease and hypertension in prisons and jails and providing coordinated, quality transition to community care upon release represents an important opportunity for reform in care for a marginalized population.
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Affiliation(s)
- Nathan Rockey
- Department of Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Lilia Cervantes
- Department of Medicine, University of Colorado School of Medicine, Aurora, USA
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Katherine LeMasters
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Katherine Rizzolo
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, 650 Albany Street, EBRC508, Boston, Massachusetts, 02118, USA.
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Testa A, Porter LC. Previous Incarceration, Health Insurance, and the Affordable Care Act in the U.S. Am J Prev Med 2023; 65:1034-1041. [PMID: 37380089 DOI: 10.1016/j.amepre.2023.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION This study examines the association between prior incarceration and health insurance status and whether living in a state adopting the Affordable Care Act (ACA) Medicaid expansion moderates this relationship. METHODS Data are from the National Longitudinal Study of Adolescent to Adult Health (Wave I [1993-1994], Wave IV [2008], and Wave V [2016-2018]; N=8,965). Multiple logistic regression with multiplicative interaction terms were performed to assess the relationship between previous incarceration and ACA Medicaid expansion on (1) being insured and (2) being on public health insurance. Analyses were performed in 2023. RESULTS Findings demonstrate a positive and statistically significant interaction in the association between previous incarceration and living in a state with ACA Medicaid expansion on having public health insurance (OR=2.402; 95% CI=1.257, 4.588). CONCLUSIONS The ACA Medicaid expansion was associated with a greater likelihood of public health insurance coverage for formerly incarcerated persons in the U.S. These findings suggest that Medicaid expansion could be critical in improving health insurance coverage among formerly incarcerated individuals who are a population that is more likely to be uninsured.
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Affiliation(s)
- Alexander Testa
- Department of Management, Policy & Community Health, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Lauren C Porter
- Department of Criminology and Criminal Justice, University of Maryland, College Park, Maryland
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Ramaswamy M, Manz C, Kouyoumdjian F, Vest N, Puglisi L, Wang E, Salyer C, Osei B, Zaller N, Rebbeck TR. Cancer equity for those impacted by mass incarceration. J Natl Cancer Inst 2023; 115:1128-1131. [PMID: 37219371 PMCID: PMC10560595 DOI: 10.1093/jnci/djad087] [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: 03/01/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023] Open
Abstract
The cancer disparities between people with incarceration histories compared with those who do not have those histories are vast. Opportunities for bolstering cancer equity among those impacted by mass incarceration exist in criminal legal system policy; carceral, community, and public health linkages; better cancer prevention, screening, and treatment services in carceral settings; expansion of health insurance; education of professionals; and use of carceral sites for health promotion and transition to community care. Clinicians, researchers, persons with a history of incarceration, carceral administrators, policy makers, and community advocates could play a cancer equity role in each of these areas. Raising awareness and setting a cancer equity plan of action are critical to reducing cancer disparities among those affected by mass incarceration.
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Affiliation(s)
- Megha Ramaswamy
- Population Health, Obstetrics and Gynecology, University of Kansas Medical Center/University of Kansas Cancer Center, Kansas City, KS, USA
| | - Christopher Manz
- Medical Oncology, Population Sciences, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | | | - Noel Vest
- Community Health Sciences, School of Public Health, Boston University, Boston, MA, USA
| | - Lisa Puglisi
- Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Emily Wang
- Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Chelsea Salyer
- Population Health, Obstetrics and Gynecology, University of Kansas Medical Center/University of Kansas Cancer Center, Kansas City, KS, USA
| | - Beverly Osei
- Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Nick Zaller
- Health Behavior and Health Education, College of Public Health, University of Arkansas Medical Sciences, Little Rock, AR, USA
| | - Timothy R Rebbeck
- Medical Oncology, Population Sciences, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
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Han BH, Bronson J, Washington L, Yu M, Kelton K, Tsai J, Finlay AK. Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans. Med Care 2023; 61:477-483. [PMID: 37204150 PMCID: PMC10330246 DOI: 10.1097/mlr.0000000000001864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Older veterans involved in the criminal legal system (CLS) may have patterns of multimorbidity that place them at risk for poor health outcomes. OBJECTIVES To estimate the prevalence of medical multimorbidity (≥2 chronic medical diseases), substance use disorders (SUDs), and mental illness among CLS-involved veterans aged 50 and older. RESEARCH DESIGN Using Veterans Health Administration health records, we estimated the prevalence of mental illness, SUD, medical multimorbidity, and the co-occurrence of these conditions among veterans by CLS involvement as indicated by Veterans Justice Programs encounters. Multivariable logistic regression models assessed the association between CLS involvement, the odds for each condition, and the co-occurrence of conditions. SUBJECTS Veterans aged 50 and older who received services at Veterans Health Administration facilities in 2019 (n=4,669,447). METHODS Mental illness, SUD, medical multimorbidity. RESULTS An estimated 0.5% (n=24,973) of veterans aged 50 and older had CLS involvement. For individual conditions, veterans with CLS involvement had a lower prevalence of medical multimorbidity compared with veterans without but had a higher prevalence of all mental illnesses and SUDs. After adjusting for demographic factors, CLS involvement remained associated with concurrent mental illness and SUD (adjusted odds ratio [aOR] 5.52, 95% CI=5.35-5.69), SUD and medical multimorbidity (aOR=2.09, 95% CI=2.04-2.15), mental illness and medical multimorbidity (aOR=1.04, 95% CI=1.01-1.06), and having all 3 simultaneously (aOR=2.42, 95% CI=2.35-2.49). CONCLUSIONS Older veterans involved in the CLS are at high risk for co-occurring mental illness, SUDs, and medical multimorbidity, all of which require appropriate care and treatment. Integrated care rather than disease-specific care is imperative for this population.
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Affiliation(s)
- Benjamin H. Han
- University of California San Diego Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, San Diego, CA
- Veterans Affairs San Diego Healthcare System, Jennifer Moreno Department of Veterans Affairs Medical Center, San Diego, CA
| | - Jennifer Bronson
- National Association of State Mental Health Program Directors Research Institute (NRI), Falls Church, VA
| | - Lance Washington
- National Association of State Mental Health Program Directors Research Institute (NRI), Falls Church, VA
| | - Mengfei Yu
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA
| | - Katherine Kelton
- South Texas Veteran Health Care System, Audie L. Murphy Veteran Hospital San Antonio, TX
| | - Jack Tsai
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Andrea K. Finlay
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA
- National Center on Homelessness Among Veterans, Department of Veterans Affairs
- Schar School of Policy and Government, George Mason University
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Divakaran B, Bloch N, Sinha M, Steiner A, Shavit S. The Reentry Health Care Hub: Creating a California-Based Referral System to Link Chronically Ill People Leaving Prison to Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105806. [PMID: 37239534 DOI: 10.3390/ijerph20105806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
People released from prison experience high health needs and face barriers to health care in the community. During the COVID-19 pandemic, people released early from California state prisons to under-resourced communities. Historically, there has been minimal care coordination between prisons and community primary care. The Transitions Clinic Network (TCN), a community-based non-profit organization, supports a network of California primary care clinics in adopting an evidence-based model of care for returning community members. In 2020, TCN linked the California Department of Corrections and Rehabilitation (CDCR) and 21 TCN-affiliated clinics to create the Reentry Health Care Hub, supporting patient linkages to care post-release. From April 2020-August 2022, the Hub received 8420 referrals from CDCR to facilitate linkages to clinics offering medical, behavioral health, and substance use disorder services, as well as community health workers with histories of incarceration. This program description identifies care continuity components critical for reentry, including data sharing between carceral and community health systems, time and patient access for pre-release care planning, and investments in primary care resources. This collaboration is a model for other states, especially after the Medicaid Reentry Act and amid initiatives to improve care continuity for returning community members, like California's Medicaid waiver (CalAIM).
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Affiliation(s)
- Bethany Divakaran
- San Francisco Public Health Foundation Project, Transitions Clinic Network, San Francisco, CA 94102, USA
| | - Natania Bloch
- San Francisco Public Health Foundation Project, Transitions Clinic Network, San Francisco, CA 94102, USA
| | - Mahima Sinha
- School of Public Health, University of California-Berkeley, Berkeley, CA 94704, USA
| | - Anna Steiner
- San Francisco Public Health Foundation Project, Transitions Clinic Network, San Francisco, CA 94102, USA
| | - Shira Shavit
- San Francisco Public Health Foundation Project, Transitions Clinic Network, San Francisco, CA 94102, USA
- School of Community Family Medicine, University of California-San Francisco, San Francisco, CA 94103, USA
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Updyke A, Ghose T. "We're the CHATS old-heads": Engaging with evidence-based practice in a reentry agency. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:945-961. [PMID: 36383698 DOI: 10.1002/jcop.22964] [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: 07/18/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Philadelphia has one of the country's largest populations re-entering society after incarceration. Reentry services have been critiqued for their ineffectiveness. Scholars note the lack of evidence-based practices (EBPs) in the field, and the challenges of translating them. Through a case study of one reentry agency implementing an EBP, we examine engagement with the intervention by clients and service providers. Qualitative interviews were conducted with clients and staff (n = 35). A grounded theory using sensitizing concepts approach was used to analyze the data. Productive engagement with the intervention was facilitated by: (1) translatability of the core EBP elements so that they addressed client and staff needs, (2) accessibility to the intervention by enhancing subjective ownership and successfully navigating logistical barriers, and (3) collectivity among participants and staff that helped them address societal and structural barriers. Productive engagement with an EBP can resist carceral processes in reentry service-provision.
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Affiliation(s)
- Alison Updyke
- Department of Graduate Social Work, West Chester University, West Chester, Pennsylvania, USA
| | - Toorjo Ghose
- School of Social Policy and Practice, University of Pennsylvania, Pennsylvania, Philadelphia, USA
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Zhao J, Han X, Zheng Z, Fan Q, Shi K, Fedewa S, Yabroff KR, Nogueira L. Incarceration History and Health Insurance and Coverage Changes in the U.S. Am J Prev Med 2023; 64:334-342. [PMID: 36411143 DOI: 10.1016/j.amepre.2022.09.023] [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] [Received: 04/12/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study examines the association of incarceration history and health insurance coverage and coverage changes in the U.S. METHODS Individuals with and without incarceration history were identified from the National Longitudinal Survey of Youth 1997 with follow-up through 2017-2018 (n=7,417). Generalized estimating equations were used to examine the associations between incarceration history and health insurance and coverage changes in the past 12 months. This study also assessed variation in associations by incarceration duration, frequency, and recency and reoffence history. Analysis was conducted in 2022. RESULTS Individuals with incarceration history were more likely to be uninsured (AOR=1.69; 95% CI=1.55, 1.85) and to experience year-long uninsurance (AOR=1.34; 95% CI=1.12, 1.59) and were less likely to have stable health insurance coverage (AOR=1.30; 95% CI=1.08, 1.56) than individuals without incarceration history. Longer duration and more frequent incarcerations were associated with a higher likelihood of lack of and unstable insurance coverage and year-long uninsurance. CONCLUSIONS People with an incarceration history had worse access to health insurance coverage. Targeted programs to improve health insurance coverage may reduce disparities associated with incarceration.
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Affiliation(s)
- Jingxuan Zhao
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia.
| | - Xuesong Han
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Qinjin Fan
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kewei Shi
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey Fedewa
- Department of Hematology and Oncology, School of Medicine, Emory University, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Leticia Nogueira
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
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14
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Onyeali R, Howell BA, McInnes DK, Emerson A, Williams ME. The case for transitional services and programs for older adults reentering society: a narrative review of US departments of correction and recommendations. Int J Prison Health 2023; 19:4-19. [PMID: 36757114 PMCID: PMC10123961 DOI: 10.1108/ijph-08-2021-0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/25/2022] [Accepted: 05/26/2022] [Indexed: 02/10/2023]
Abstract
PURPOSE Older adults who are or have been incarcerated constitute a growing population in the USA. The complex health needs of this group are often inadequately addressed during incarceration and equally so when transitioning back to the community. The purpose of this paper is to discuss the literature on challenges older adults (age 50 and over) face in maintaining health and accessing social services to support health after an incarceration and to outline recommendations to address the most urgent of these needs. DESIGN/METHODOLOGY/APPROACH This study conducted a narrative literature review to identify the complex health conditions and health services needs of incarcerated older adults in the USA and outline three primary barriers they face in accessing health care and social services during reentry. FINDINGS Challenges to healthy reentry of older adults include continuity of health care; housing availability; and access to health insurance, disability and other support. The authors recommend policy changes to improve uniformity of care, development of support networks and increased funding to ensure that older adults reentering communities have access to resources necessary to safeguard their health and safety. ORIGINALITY/VALUE This review presents a broad perspective of the current literature on barriers to healthy reentry for older adults in the USA and offers valuable system, program and policy recommendations to address those barriers.
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Affiliation(s)
- Rose Onyeali
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA and is a Clinical Assistant Professor at Geriatric Department, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benjamin A. Howell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, USA
| | - D. Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA and Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amanda Emerson
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Monica E. Williams
- Center for the Study of Aging, Rand Corporation, Arlington, Virginia, USA
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15
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Saloner B, Li W, Flores M, Progovac AM, Lê Cook B. A Widening Divide: Cigarette Smoking Trends Among People With Substance Use Disorder And Criminal Legal Involvement. Health Aff (Millwood) 2023; 42:187-196. [PMID: 36745833 PMCID: PMC10157835 DOI: 10.1377/hlthaff.2022.00901] [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] [Indexed: 02/08/2023]
Abstract
People with substance use disorder (SUD) smoke cigarettes at a rate more than twice that of the general population. Policies and programs have focused on promoting smoking cessation among people with SUD, yet it is unclear whether interventions have adequately reached the subgroup involved in the criminal legal system, who have among the highest smoking rates. Drawing on repeated cross-sections of the National Survey on Drug Use and Health, we found that smoking rates declined by 9.4 percentage points overall among people with SUD from 2010 to 2019, but rates remained virtually unchanged among the subgroup with criminal legal involvement. In regression analyses focused on people with SUD, three-quarters of the excess smoking burden for those with criminal legal involvement at baseline (2010-13) was accounted for by controlling for sociodemographics, substance use type, health insurance, and recent SUD treatment. However, even after we controlled for these same factors, the disparity in smoking prevalence among people with SUD between those with and without criminal legal involvement remained constant over time. These findings underscore the need for smoking cessation interventions focused on the criminal legal system, including correctional facilities and SUD treatment programs that serve people in this population.
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Affiliation(s)
- Brendan Saloner
- Brendan Saloner , Johns Hopkins University, Baltimore, Maryland
| | - Wenshu Li
- Wenshu Li, Foundation Medicine, Cambridge, Massachusetts
| | - Michael Flores
- Michael Flores, Cambridge Health Alliance and Harvard University, Cambridge, Massachusetts
| | - Ana M Progovac
- Ana M. Progovac, Cambridge Health Alliance and Harvard University
| | - Benjamin Lê Cook
- Benjamin Lê Cook, Cambridge Health Alliance and Harvard University
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16
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Nguyen A, Shadowen H, Shadowen C, Thakkar B, Knittel AK, Martin CE. Incarceration status at buprenorphine initiation and OUD treatment outcomes during pregnancy. Front Psychiatry 2023; 14:1157611. [PMID: 37124262 PMCID: PMC10133465 DOI: 10.3389/fpsyt.2023.1157611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Opioid use disorder (OUD) is a leading cause of pregnancy-associated deaths. OUD treatment with buprenorphine (BUP) reduces overdose risk and improves perinatal outcomes. Incarceration can be a barrier to receipt of OUD treatment during pregnancy and postpartum. The objective of this study was to examine differences in BUP continuation at delivery by patients' incarceration status at the time of BUP initiation. Methods This is a secondary analysis of a retrospective cohort study of pregnant patients with OUD who delivered at an academic medical center and initiated BUP between January 1, 2018, and March 30, 2020. The primary outcome was BUP continuation at delivery, abstracted from the state prescription monitoring program and electronic medical record, along with incarceration status. Bivariate analysis was used to assess the relationship between BUP continuation and incarceration status. Results Our sample included 76 patients, with 62% of patients incarcerated at BUP initiation (n = 47). Among the entire sample, 90.7% (n = 68) received BUP at delivery. Among patients who were incarcerated at BUP initiation, 97% remained on BUP at delivery; among patients who were not incarcerated at BUP initiation, 79% remained on BUP at delivery (p = 0.02). Conclusion In our sample from a health system housing a care model for pregnant and parenting people with OUD with local jail outreach, BUP continuation rates at delivery were high, both for patients who were and were not incarcerated at BUP initiation. Findings are intended to inform future work to develop and evaluate evidence-based, patient-centered interventions to expand OUD treatment access for incarcerated communities.
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Affiliation(s)
- Andrea Nguyen
- School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Hannah Shadowen
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States
| | - Caroline Shadowen
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Bhushan Thakkar
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States
- *Correspondence: Caitlin E. Martin,
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17
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Donohue JM, Cole ES, James CV, Jarlenski M, Michener JD, Roberts ET. The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity. JAMA 2022; 328:1085-1099. [PMID: 36125468 DOI: 10.1001/jama.2022.14791] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Medicaid is the largest health insurance program by enrollment in the US and has an important role in financing care for eligible low-income adults, children, pregnant persons, older adults, people with disabilities, and people from racial and ethnic minority groups. Medicaid has evolved with policy reform and expansion under the Affordable Care Act and is at a crossroads in balancing its role in addressing health disparities and health inequities against fiscal and political pressures to limit spending. OBJECTIVE To describe Medicaid eligibility, enrollment, and spending and to examine areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity. EVIDENCE REVIEW Analyses of publicly available data reported from 2010 to 2022 on Medicaid enrollment and program expenditures were performed to describe the structure and financing of Medicaid and characteristics of Medicaid enrollees. A search of PubMed for peer-reviewed literature and online reports from nonprofit and government organizations was conducted between August 1, 2021, and February 1, 2022, to review evidence on Medicaid managed care, delivery system reforms, expansion, and health disparities. Peer-reviewed articles and reports published between January 2003 and February 2022 were included. FINDINGS Medicaid covered approximately 80.6 million people (mean per month) in 2022 (24.2% of the US population) and accounted for an estimated $671.2 billion in health spending in 2020, representing 16.3% of US health spending. Medicaid accounted for an estimated 27.2% of total state spending and 7.6% of total federal expenditures in 2021. States enrolled 69.5% of Medicaid beneficiaries in managed care plans in 2019 and adopted 139 delivery system reforms from 2003 to 2019. The 38 states (and Washington, DC) that expanded Medicaid under the Affordable Care Act experienced gains in coverage, increased federal revenues, and improvements in health care access and some health outcomes. Approximately 56.4% of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. Expanding Medicaid, addressing disparities within Medicaid, and having an explicit focus on equity in managed care and delivery system reforms may represent opportunities for Medicaid to advance health equity. CONCLUSIONS AND RELEVANCE Medicaid insures a substantial portion of the US population, accounts for a significant amount of total health spending and state expenditures, and has evolved with delivery system reforms, increased managed care enrollment, and state expansions. Additional Medicaid policy reforms are needed to reduce health disparities by race and ethnicity and to help achieve equity in access, quality, and outcomes.
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Affiliation(s)
- Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Evan S Cole
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | | | - Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Jamila D Michener
- Department of Government and School of Public Policy, Cornell University, Ithaca, New York
| | - Eric T Roberts
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
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18
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Barnert ES, Scannell C, Ashtari N, Albertson E. Policy Solutions to End Gaps in Medicaid Coverage during Reentry after Incarceration in the United States: Experts' Recommendations. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 30:2201-2209. [PMID: 36172337 PMCID: PMC9512259 DOI: 10.1007/s10389-021-01483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
Aims We sought to gather experts' perspectives on Medicaid coverage gaps during reentry to identify high-yield policy solutions to improve the health of justice-involved individuals in the United States. Subject and Methods We interviewed 28 experts at the intersection of Medicaid and criminal justice via telephone between November 2018 and April 2019. Interviewees included Medicaid administrators, health and justice officials, policy makers, and health policy researchers. We performed thematic analysis of semi-structured interview transcripts to identify emergent themes and distill policy recommendations. Results Three themes emerged: 1) Medicaid coverage gaps during reentry contribute to poor health outcomes and recidivism, 2) Excessive burden on justice-involved people to re-activate Medicaid leads to coverage gaps, and 3) Scalable policy solutions exist to eliminate Medicaid coverage gaps during reentry. Policy recommendations centered on ending the federal "inmate exclusion," delaying Medicaid de-activation at intake, and promoting re-activation by reentry. Experts viewed coverage gaps as problematic, viewed current approaches as inefficient and burdensome to families and systems, and recommended several policy solutions. Conclusion By pursuing strategies to eliminate Medicaid gaps during reentry, policymakers can improve health outcomes and efficiency of government spending on healthcare, and may reduce cycles of incarceration.
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Affiliation(s)
- Elizabeth S Barnert
- UCLA, David Geffen School of Medicine at UCLA, Department of Pediatrics, 10833 Le Conte Ave, Los Angeles, CA 90095
- Mattel Children's Hospital, Children's Discovery & Innovation Institute, 757 Westwood Plaza, Los Angeles, CA 90095
| | - Christopher Scannell
- UCLA/VA National Clinician Scholars Program, 1100 Glendon Ave, Suite 900, Los Angeles, CA 90095
| | - Neda Ashtari
- UCLA, David Geffen School of Medicine at UCLA, Department of Pediatrics, 10833 Le Conte Ave, Los Angeles, CA 90095
- Mattel Children's Hospital, Children's Discovery & Innovation Institute, 757 Westwood Plaza, Los Angeles, CA 90095
| | - Eleanor Albertson
- UCLA, UCLA Fielding School of Public Health, Department of Health Policy & Management, 650 Charles E Young Dr, Los Angeles, CA 90095
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19
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Latham-Mintus K, Deck MM, Nelson E. Aging with Incarceration Histories: An Intersectional Examination of Incarceration and Health Outcomes among Older Adults. J Gerontol B Psychol Sci Soc Sci 2022; 78:853-865. [PMID: 35767847 DOI: 10.1093/geronb/gbac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Experiences with incarceration are linked to poor mental and physical health across the life course. The purpose of this research is to examine whether incarceration histories are associated with worse physical and mental health among older adults. We apply an intersectionality framework and consider how the intersection of sexism and racism leads to unequal health outcomes following incarceration among women and people of color. METHODS We employ two measures of health (i.e., number of depressive symptoms and physical limitations) to broadly capture mental and physical health. Using data from Waves 11 and 12 of the Health and Retirement Study (HRS), we estimated a series of general linear models (GLM) to analyze differences in health by incarceration history, gender/sex, and race/ethnicity. RESULTS Findings suggest that experiences with incarceration are associated with a greater number of physical limitations and more depressive symptoms among older men and women, net of sociodemographic characteristics, early-life conditions, and lifetime stressful events. Formerly incarcerated women, particularly women of color, had more physical limitations and depressive symptoms, relative to other groups. DISCUSSION These findings suggest that incarceration histories have far-reaching health implications. Older women of color with incarceration histories experience markedly high levels of physical limitations and depressive symptoms in later life.
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Affiliation(s)
| | | | - Elizabeth Nelson
- Medical Humanities and Health Studies Program, School of Liberal Arts, IUPUI
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20
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Saloner B, Li W, Bandara SN, McGinty EE, Barry CL. Trends In The Use Of Treatment For Substance Use Disorders, 2010-19. Health Aff (Millwood) 2022; 41:696-702. [PMID: 35500189 PMCID: PMC10161241 DOI: 10.1377/hlthaff.2021.01767] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rapidly rising drug overdose rates in the United States during the past decade underscore the need to increase access to treatment among people with substance use disorders (SUDs). We analyzed trends in the use of treatment services among people with SUDs during the period 2010-19, using data from the National Survey on Drug Use and Health. Compared with 2013, outpatient visits for general health in the prior year increased 3.6 percentage points by the 2017-19 period. Use of any SUD treatment in the prior year remained unchanged, but treatment use among people involved in the criminal legal system increased by about 6.2 percentage points by the end of the study period. Among those receiving SUD treatment, there was a 14.9-percentage-point increase in having treatment paid for by Medicaid between 2010-13 and 2017-19. Although access to general medical care and insurance coverage have improved for people with SUD, our study findings underscore the importance of renewed efforts to increase the use of SUD treatment.
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Affiliation(s)
- Brendan Saloner
- Brendan Saloner , Johns Hopkins University, Baltimore, Maryland
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21
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Howell BA, Hawks L, Wang EA, Winkelman TNA. Evaluation of Changes in US Health Insurance Coverage for Individuals With Criminal Legal Involvement in Medicaid Expansion and Nonexpansion States, 2010 to 2017. JAMA HEALTH FORUM 2022; 3:e220493. [PMID: 35977325 PMCID: PMC8994123 DOI: 10.1001/jamahealthforum.2022.0493] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/18/2022] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study compares changes in health insurance coverage from 2010 to 2017 for low-income US adults with criminal legal involvement in states that did and did not adopt the Medicaid expansion provision of the Affordable Care Act.
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Affiliation(s)
- Benjamin A. Howell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut
| | - Laura Hawks
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Emily A. Wang
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut
| | - Tyler N. A. Winkelman
- Health, Homelessness, and Criminal Justice Laboratory, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
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22
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Khatri UG, Bilger A, Zeidan A, Meisel Z, Delgado MK, Samuels-Kalow M, South E. "A Catch-22": A Firsthand Account of Barriers and Facilitators to Accessing Health Care During Reentry. JOURNAL OF CORRECTIONAL HEALTH CARE 2022; 28:109-116. [PMID: 35244474 DOI: 10.1089/jchc.20.01.0001] [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: 11/12/2022]
Abstract
Although a history of incarceration is associated with poor long-term health status, the experience of seeking health care access during reentry is complex. Semistructured open-ended interviews were conducted among individuals with a recent history of incarceration (N = 20). The majority of participants were male (90%) and African American (80%). The majority (55%) had one or more chronic medical conditions, 40% reported active substance addiction, and 75% reported having a chronic psychiatric condition. In qualitative analysis, participants described the three biggest facilitators to accessing health care as eligibility for Medicaid, support through reentry organizations, and online resources. Participants said the major barriers to accessing health care were multiple and competing priorities, limitations of Medicaid, and lack of access to health records. Ensuring individuals with a history of incarceration are connected to the public assistance programs for which they are eligible is an important public health initiative and may facilitate successful reintegration.
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Affiliation(s)
- Utsha G Khatri
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Emergency Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Bilger
- National Center for Integrated Behavioral Health in the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amy Zeidan
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zachary Meisel
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M Kit Delgado
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Margaret Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eugenia South
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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23
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Scannell C, Albertson EM, Ashtari N, Barnert ES. Reducing Medicaid Coverage Gaps for Youth During Reentry. JOURNAL OF CORRECTIONAL HEALTH CARE 2022; 28:39-46. [PMID: 34936482 PMCID: PMC9041400 DOI: 10.1089/jchc.20.03.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Although many justice-involved youth (JIY) rely on Medicaid, due to the federal "inmate exclusion" Medicaid is often suspended or terminated upon youth's intake to detention, which can lead to coverage gaps at release. We interviewed 28 experts on Medicaid and the justice system and conducted thematic analysis to identify solutions for reducing Medicaid coverage gaps during reentry. Participants viewed coverage gaps during reentry as a significant public health problem to which JIY are especially vulnerable. Recommended solutions for reducing coverage gaps for JIY included (a) leave Medicaid activated, (b) reactivate Medicaid before or during reentry, (c) enhance interagency collaboration, and (d) address societal context to ensure health care access for Medicaid-eligible JIY. Doing so may improve health outcomes and reduce cycles of youth incarceration.
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Affiliation(s)
- Christopher Scannell
- VA/UCLA National Clinician Scholars Program, Los Angeles, California, USA.,Address correspondence to: Christopher Scannell, MD, PhD, VA/UCLA National Clinician Scholars Program, 1100 Glendon Ave., Suite 900, Los Angeles, CA 90024, USA,
| | - Elaine Michelle Albertson
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Neda Ashtari
- UCLA Department of Pediatrics, Los Angeles, California, USA
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24
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Aziz H, Ackah RL, Whitson A, Oppong B, Obeng-Gyasi S, Sims C, Pawlik TM. Cancer Care in the Incarcerated Population: Barriers to Quality Care and Opportunities for Improvement. JAMA Surg 2021; 156:964-973. [PMID: 34406357 DOI: 10.1001/jamasurg.2021.3754] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Cancer is the leading cause of mortality in incarcerated individuals older than 45 years and the fourth leading cause of mortality overall. Health care professionals face increasing challenges to provide high-quality care under the confines of prison regulations and procedures. Observations Adjusted for age, race, sex, and year of diagnosis, the standardized incidence ratio for all cancers is more than 2-fold higher in incarcerated vs general populations. Among deaths occurring in state and federal prison systems, cancer is the overall leading cause of mortality with lung cancer being the leading cause of cancer-related mortality followed by liver, colon, and pancreatic cancers, respectively. Access to high-quality oncological services remains variable; however, cost of care represents about a fifth of overall annual prison expenditures. Given the enormous patient burden, coupled with the rushed discretionary screenings performed by jail and prison nursing staff, early cancer symptoms are often missed altogether or misdiagnosed as a chronic illness or as acute infections. As such, many incarcerated individuals present with more advanced cancer stage. Incarcerated individuals have limited, if any, access to the internet, social media, and other sources of information, which severely limits their ability to research treatment options. Within the prison setting, access to professionals with special skills in assisting with social and spiritual concerns is also generally limited, and less than 4% of prisons have hospice programs. There are no uniform quality-of-care monitoring standards for correctional systems and facilities, nor are there mechanisms for reporting comparable performance data to enforce quality control within correctional health care systems. Conclusions and Relevance There is a growing trend in cancer incidence among incarcerated patients, which is multifactorial including barriers in access to care, increased burden of chronic medical conditions, and decreased screening tests. Efforts are needed to ensure quality health care outcomes for incarcerated patients with cancer.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, Tufts School of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Ruth L Ackah
- Division of Surgical Oncology, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Amy Whitson
- Division of Trauma and Critical Care, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Bridget Oppong
- Division of Surgical Oncology, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Carrie Sims
- Division of Trauma and Critical Care, Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, Ohio State University Wexner Medical Center, Columbus.,Deputy Editor, JAMA Surgery
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Manz CR, Odayar VS, Schrag D. Disparities in cancer prevalence, incidence, and mortality for incarcerated and formerly incarcerated patients: A scoping review. Cancer Med 2021; 10:7277-7288. [PMID: 34477309 PMCID: PMC8525139 DOI: 10.1002/cam4.4251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Racial and ethnic minority status, structural racism, low educational attainment, and poverty are consistently associated with cancer disparities and with higher rates of incarceration. The objective of this scoping review is to conduct a qualitative synthesis of the literature on cancer prevalence, incidence, mortality, and disparities in these outcomes for incarcerated and formerly incarcerated patients, as this literature is fragmented and heterogenous. METHODS This scoping review included Bureau of Justice Statistics reports and searched PubMed in May 2021 for all English language studies published between 1990 and 30 April 2021, that reported on cancer prevalence, incidence, or mortality for incarcerated or formerly incarcerated individuals in the United States. RESULTS Twenty studies were selected. Data on cancer prevalence and incidence were scarce but suggested that incarcerated and formerly incarcerated patients have a similar overall risk of cancer diagnosis as the general population, but elevated risk of certain cancers such as cervical, lung, colorectal, and hepatocellular carcinoma for which effective prevention and screening interventions exist. Cancer mortality data in state and local jails as well as prisons were robust and suggests that both incarcerated and formerly incarcerated patients have higher cancer mortality than the general population. CONCLUSIONS Incarcerated and formerly incarcerated patients likely have a higher risk of dying from cancer than the general population, but important gaps in our knowledge about the extent and drivers of disparities for this population remain. Additional research is needed to guide interventions to reduce cancer disparities for patients experiencing incarceration.
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Affiliation(s)
- Christopher R. Manz
- Division of Population SciencesDepartment of Medical OncologyDana‐Farber Cancer InstituteBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | | | - Deborah Schrag
- Division of Population SciencesDepartment of Medical OncologyDana‐Farber Cancer InstituteBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
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Zhang J, Wu X. Predict Health Care Accessibility for Texas Medicaid Gap. Healthcare (Basel) 2021; 9:healthcare9091214. [PMID: 34574988 PMCID: PMC8465286 DOI: 10.3390/healthcare9091214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 11/23/2022] Open
Abstract
Medicaid is a unique approach in ensuring the below poverty population obtains free insurance coverage under federal and state provisions in the United States. Twelve states without expanded Medicaid caused two million people who were under the poverty line into health insecurity. Principal Component-based logistical regression (PCA-LA) is used to consider health status (HS) as a dependent variable and fourteen social-economic indexes as independent variables. Four composite components incorporated health conditions (i.e., “no regular source of care” (NRC), “last check-up more than a year ago” (LCT)), demographic impacts (i.e., four categorized adults (AS)), education (ED), and marital status (MS). Compared to the unadjusted LA, direct adjusted LA, and PCA-unadjusted LA three methods, the PCA-LA approach exhibited objective and reasonable outcomes in presenting an odd ratio (OR). They included that health condition is positively significant to HS due to beyond one OR, and negatively significant to ED, AS, and MS. This paper provided quantitative evidence for the Medicaid gap in Texas to extend Medicaid, exposed healthcare geographical inequity, offered a sight for the Centers for Disease Control and Prevention (CDC) to improve the Medicaid program and make political justice for the Medicaid gap.
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Affiliation(s)
- Jinting Zhang
- School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China;
| | - Xiu Wu
- Department of Geography, Texas State University, San Marcos, TX 78666, USA
- Correspondence: ; Tel.: +1-512-781-0041
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Wurcel AG, Reyes J, Zubiago J, Koutoujian PJ, Burke D, Knox TA, Concannon T, Lemon SC, Wong JB, Freund KM, Beckwith CG, LeClair AM. "I'm not gonna be able to do anything about it, then what's the point?": A broad group of stakeholders identify barriers and facilitators to HCV testing in a Massachusetts jail. PLoS One 2021; 16:e0250901. [PMID: 34038430 PMCID: PMC8153419 DOI: 10.1371/journal.pone.0250901] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite national guidelines promoting hepatitis C virus (HCV) testing in prisons, there is substantial heterogeneity on the implementation of HCV testing in jails. We sought to better understand barriers and opportunities for HCV testing by interviewing a broad group of stakeholders involved in HCV testing and treatment policies and procedures in Massachusetts jails. METHODS We conducted semi-structured interviews with people incarcerated in Middlesex County Jail (North Billerica, MA), clinicians working in jail and community settings, corrections administrators, and representatives from public health, government, and industry between November 2018-April 2019. RESULTS 51/120 (42%) of people agreed to be interviewed including 21 incarcerated men (mean age 32 [IQR 25, 39], 60% non-White). Themes that emerged from these interviews included gaps in knowledge about HCV testing and treatment opportunities in jail, the impact of captivity and transience, and interest in improving linkage to HCV care after release. Many stakeholders discussed stigma around HCV infection as a factor in reluctance to provide HCV testing or treatment in the jail setting. Some stakeholders expressed that stigma often led decisionmakers to estimate a lower "worth" of incarcerated individuals living with HCV and therefore to decide against paying for HCV testing.". CONCLUSION All stakeholders agreed that HCV in the jail setting is a public health issue that needs to be addressed. Exploring stakeholders' many ideas about how HCV testing and treatment can be approached is the first step in developing feasible and acceptable strategies.
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Affiliation(s)
- Alysse G. Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Jessica Reyes
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Julia Zubiago
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | | | - Deirdre Burke
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | - Tamsin A. Knox
- Tufts University School of Medicine, Boston, MA, United States of America
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | - Thomas Concannon
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | - Stephenie C. Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - John B. Wong
- Tufts University School of Medicine, Boston, MA, United States of America
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
| | - Karen M. Freund
- Tufts University School of Medicine, Boston, MA, United States of America
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
- Department of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America
| | - Curt G. Beckwith
- Division of Infectious Diseases, Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Amy M. LeClair
- Department of Medicine, Tufts Medical Center, Boston, MA, United States of America
- Department of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America
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Transitioning into the Community: Perceptions of Barriers and Facilitators Experienced By Formerly Incarcerated, Homeless Women During Reentry-A Qualitative Study. Community Ment Health J 2021; 57:609-621. [PMID: 33387178 PMCID: PMC8514107 DOI: 10.1007/s10597-020-00748-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
Formerly incarcerated, homeless women on parole or probation experience individual-and structural-level barriers and facilitators as they prepare to transition into the community during reentry. A qualitative study was undertaken using focus group methods with formerly incarcerated, currently homeless women (N = 18, Mage = 37.67, SD 10.68, 23-53 years of age) exiting jail or prison. Major themes which emerged included the following: (1) access to resources-barriers and facilitators during community transition, (2) familial reconciliation and parenting during community transition, and (3) trauma and self-care support during community transition. These findings suggest a need to develop multi-level interventions at the individual, program and institutional/societal level with a gender-sensitive lens for women who are transitioning to community reentry. It is hoped that providing such resources will reduce the likelihood of homelessness and reincarceration.
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Abstract
OBJECTIVE To describe the number of admissions of pregnant people to U.S. jails and the outcomes of pregnancies that end in custody. METHODS We prospectively collected pregnancy data from six U.S. jails, including the five largest jails, on a monthly basis for 12 months. Jails reported de-identified, aggregate numbers of pregnant people admitted, births, preterm births, cesarean deliveries, miscarriages, induced abortions, ectopic pregnancies, and maternal and newborn deaths. RESULTS There were 1,622 admissions of pregnant people in 12 months in the selected jails. The highest 1-day count of pregnant people at a single jail was 65. The majority of these admissions involved the release of a pregnant person. Of the 224 pregnancies that ended in jail, 144 (64%) were live births, 41 (18%) were miscarriages, 33 (15%) were induced abortions, and four were ectopic (1.8%). One third of the births were cesarean deliveries and 8% were preterm. There were two stillbirths, one newborn death, and no maternal deaths. CONCLUSION About 3% of admissions of females to U.S. jails are of pregnant people; extrapolating study results to national female jail admission rates suggests nearly 55,000 pregnancy admissions in 1 year. It is feasible to track pregnancy statistics about this overlooked group.
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