Total Worker Health® Needs Assessment to Identify Workplace Mental Health Interventions in Rural and Urban Jails

COVID-19 Preparedness, Stressors, and Data-Driven Solutions for Healthcare Workers at a Regional Rural-Urban Hospital System: A Longitudinal Total Worker Health® Study

BACKGROUND

During the COVID-19 pandemic in the United States, healthcare workers were devastated by the insufficient preparedness to respond to their patients' and personal health needs. A gap exists in resources to prevent or reduce acute and long-term healthcare worker mental illnesses resulting from COVID-19 frontline response.

METHODS

We performed an exploratory, mixed methods, longitudinal study of healthcare workers at a regional rural-urban hospital system in the Midwest United States during the COVID-19 response (4 timepoints, 2020). Using the Total Worker Health® (TWH) participatory needs assessment approach, self-identified frontline COVID-19 workers participated in a survey including Health-Related Quality of Life, Impact of Event Scale, and a modified version of the American Nursing Association COVID-19 survey; and a hospital timeline tracked system-level activities.

FINDINGS

Response rate at Timepoint (T)1 was 21.7% (N = 39) and of those, 14 (36%) completed all four surveys. From T1 to T4, the rate of COVID-19 patients steadily increased, staff exceeded the threshold for post-traumatic stress disorder at T1 and T4; staff reported not enough rest or sleep 50% of the month, T1-T4. Helpfulness of family support increased but community support decreased, T1-T4. Concerns with performing new tasks increased; the challenges related to lack of protective equipment and negative media decreased. Workers wanted to be involved in decision-making, desired timely communication, and needed adequate physical, environmental, and psychological supports.

CONCLUSIONS/APPLICATIONS FOR PRACTICE

Utilization of a TWH® strategy for describing health needs, hospital response, and multi-level staff suggestions to workplace health solutions during the COVID-19 pandemic identified evidence-based health promotion interventions in a hospital system.

Impact of seating and mobility services for individuals with disabilities in Peru

The purpose of this study is to critically analyze the perceived impact of seating and mobility services, provided by occupational therapists using an ISL model, from the perspective of the recipients of services in Peru. A quantitative, cross-sectional survey design was implemented using a survey that was developed based on areas of occupation outlined by the OTPF-4, translated into Spanish, and administered by an in-country partner via SurveyMonkey. More than 85% of respondents (n = 133) indicated they "agree" or "strongly agree" that receiving services had an overall positive impact on their life, ability to complete ADLs, social interaction, community mobility and participation, overall health, and sense of confidence and well-being; responses were generally "neutral" regarding impact on employment and education. The results support the potential of collaborative ISL, specific to the provision of seating and mobility, to improve occupational performance from the perspective of service recipients in Peru.

Integrated Safety and Health Promotion among Correctional Workers and People Incarcerated: A Scoping Review

Improving safety and health for correctional workers and people who are incarcerated are widespread yet separate initiatives. Correctional workers and people who are incarcerated experience similar challenges involved with poor workplaces and living conditions, including mental health crises, violence, stress, and chronic health issues, and the available resources lack integration with respect to safety and health promotion. This scoping review sought to contribute to an integrated approach for correctional system safety and health resources and identify studies of correctional resources that address health promotion among correctional workers and people who are incarcerated. Guided by PRISMA, a search of gray literature, also termed peer-reviewed literature, published between 2013-2023 (n = 2545) was completed, and 16 articles were identified. Resources primarily targeted individual and interpersonal levels. At every level of intervention, resources improved the environment for both workers and those incarcerated, with trends of less conflict, more positive behaviors, and improved relations, access to care, and feelings of safety. The corrections environment is impacted by changes from both workers and people who are incarcerated and should be examined using a holistic approach. Future health and safety resources should target the larger correctional environment by utilizing practices, policies, and procedures to improve safety and health for incarcerated people and workers.

Stakeholder-engaged research is necessary across the criminal-legal spectrum

People with lived experience of incarceration have higher rates of morbidity and mortality compared to people without history of incarceration. Research conducted unethically in prisons and jails led to increased scrutiny of research to ensure the needs of those studied are protected. One consequence of increased restrictions on research with criminal-legal involved populations is reluctance to engage in research evaluations of healthcare for people who are incarcerated and people who have lived experience of incarceration. Ethical research can be done in partnership with people with lived experience of incarceration and other key stakeholders and should be encouraged. In this article, we describe how stakeholder engagement can be accomplished in this setting, and further, how such engagement leads to impactful research that can be disseminated and implemented across disciplines and communities. The goal is to build trust across the spectrum of people who work, live in, or are impacted by the criminal-legal system, with the purpose of moving toward health equity.

Interprofessional and community engagement for evaluating and growing evidence-based criminal justice practice and policy

People experiencing incarceration are often invisible to the public due to the restricted settings in which they reside and receive services. Limited access to criminal justice settings leaves policymakers and healthcare professionals with sparse information to understand the unique needs of this population. The unmet needs of justice-involved individuals are more likely observed by professionals who provide services in correctional settings. We provide three distinct examples of projects conducted within correctional settings and how they formed pathways to interdisciplinary research and community partnerships to address the unique health and social needs of incarcerated individuals. Our partnerships in a variety of correctional settings led to exploratory research of women and men's prepregnancy health needs, participatory workplace health interventions, and process evaluation of reentry programming. The limitations and challenges to research in correctional settings are considered along with the clinical and policy implications of these projects.

Critical incident exposure among custody and noncustody correctional workers: Prevalence and impact of violent exposure to work-related trauma

BACKGROUND

Correctional workers are at high risk for exposure to trauma, both as direct violence and as threats to their safety and well-being. The distress associated with these critical incidents (CIs) affects mental and physical health. Current tools are limited for detecting CIs in this workforce and are therefore insufficient for addressing correctional worker trauma.

METHODS

Community prison employees (N = 105) self-reported CIs using the adapted Correctional Worker Critical Incident Survey (CWCIS). We examined: (1) prevalence of CIs and occurrences, (2) differences in exposures to CIs by custody and noncustody staff, and (3) differences in job satisfaction, posttraumatic stress (PTSD), lower back disease, and health behaviors, such as missed work and sleep.

RESULTS

CIs occurred among most staff (59%) and more often for custody staff as compared to noncustody staff. CIs most often experienced were coworker injury, exposure to disease, and badly beaten adults (frequency 10-50). For the 1-9 frequency category, the most described events were: seeing someone dying, life threatened, and coworker injury. PTSD was identified in 44% of staff, and those who experienced CIs reported lower job satisfaction, greater feelings of PTSD, and more work absences than those not experiencing CIs (p < 0.05).

CONCLUSIONS

CIs and PTSD are prevalent among custody and noncustody correctional workers; and job dissatisfaction, PTSD, and work absence are significantly worse for those who experienced CIs. The CWCIS detected CIs; future study is needed to inform trauma prevention, reduction, and rehabilitation interventions specific to correctional work.

Suffering in Silence: Violence Exposure and Post-Traumatic Stress Disorder Among Jail Correctional Officers

OBJECTIVE

Correctional officers are exposed to violence more often than many other public service workers, yet little is known about the traumatic nature of these risks. We examine violence exposure and post-traumatic stress disorder (PTSD) among a large, multi-facility sample of jail officers.

METHOD

One thousand three hundred and sixty five officers working in 20 jails were surveyed regarding background characteristics, exposure to violence at work, and post-traumatic stress symptoms measured by the PTSD Checklist for DSM-5 (PCL-5).

RESULTS

About one-third of the sample met the criteria for a "provisional PTSD Diagnosis" or "probable PTSD".' Victimization and exposure to violence, both in and outside of work, significantly contributed to PTSD symptoms.

CONCLUSIONS

Findings highlight the severity of, and link between, exposure to violence and PTSD among jail officers. Implications for diagnosing, treating, and preventing PTSD among jail officers are discussed.

Work-Family Conflict, Depression, and Burnout Among Jail Correctional Officers: A 1-Year Prospective Study

BACKGROUND

Correctional officers (COs) experience elevated rates of mental and physical ill-health as compared with other general industry and public safety occupations. The purpose of this study was to investigate demographic, mental health, job tenure, and work-family characteristics and their prospective association to burnout within and between jail officers during one year of new employment.

METHODS

In 2016, newly hired jail officers (N = 144) completed self-reported surveys across four time points in a one-year prospective study at a Midwestern United States urban jail. Linear mixed-effects and growth modeling examined how work-family conflict (W-FC) and depressive symptoms relate to perceptions of burnout over time.

RESULTS

Jail officer burnout increased and was related to rises in W-FC and depression symptoms. Within-person variance for W-FC (B pooled  = .52, p < .001) and depression symptoms (B pooled  = .06, p < .01) were significant predictors of burnout. Less time on the job remained a significant predictor of burnout across all analyses (B pooled  = .03, p < .001).

CONCLUSIONS

Results from this study indicate that burnout increased during the first year of new employment; and increased W-FC, higher depression, and brief tenure were associated with burnout among jail COs. Future study of correctional workplace health is needed to identify tailored, multilevel interventions that address burnout and W-FC prevention and early intervention among COs.

Progress in Corrections Worker Health: The National Corrections Collaborative Utilizing a Total Worker Health® Strategy

OBJECTIVE

To examine National Corrections Collaborative (NCC) activities, as an outreach initiative, to advance corrections workplace health and safety research, practice, and policy through a series of applied Research to Practice (r2p) meetings informed by the Total Worker Health(Total Worker Health is a registered trademark of the U.S. Department of Health and Human Services) (TWH) strategy.

METHODS

We mapped the coalescence of correctional worker health concerns, federal and national professional organization initiatives, and research activities that formed the NCC in 2014.

RESULTS

During the NCC's 5-years of TWH activities, attendance increased, partner composition expanded, and themes of concern evolved. Partners were motivated to participate and work together towards building evidence for health and safety r2p.

CONCLUSIONS

A unified plea to the academic and federal research communities for assistance with better evaluation instruments, data linkages, and for adopting an integrated TWH approach to workforce health and wellbeing continue to drive NCC r2p activities.

Evaluation of the Jail-Based Occupational Therapy Transition and Integration Services Program for Community Reentry

IMPORTANCE

Transition and integration reentry services continue to grow in carceral settings; however, related provision of occupational therapy is limited.

OBJECTIVE

To examine the implementation fidelity of an occupational therapy-administered interprofessional reentry program initiated in an urban jail.

DESIGN

Retrospective, mixed quantitative and qualitative design.

SETTING

Community-based reentry services provided prerelease in a Midwestern urban jail and postrelease in the local St. Louis community.

PARTICIPANTS

Occupational therapy practitioners tracking process measures for identifying reentry project feasibility.

INTERVENTION

Provision of recruitment, assessment, and skilled occupational therapy services with people held in a short-term jail facility and follow-up during community reentry.

OUTCOME AND MEASURES

Detailed logs were analyzed to describe attendance at and duration of sessions. We coded barriers to and facilitators of implementation from weekly team meeting notes and logs using social-ecological categories.

RESULTS

Findings indicate that it was feasible to implement prerelease jail-based services (N = 63) because of jail operations and community partnerships (facilitators) and to overcome institutional policies and environmental limitations (barriers). Full 8-wk prerelease programming was completed by 38% (n = 24) of participants, and 52% (n = 33) participated less than 8 wk. All who completed the full prerelease program and transitioned to the community (n = 15) initiated postrelease occupational therapy services.

CONCLUSIONS AND RELEVANCE

The iterative feedback provided by process evaluation supported the feasibility of implementing the jail-based Occupational Therapy Transition and Integration Services program.

WHAT THIS ARTICLE ADDS

This process evaluation provides evidence that implementation of an occupational therapy-based transition program in an urban jail is feasible.