The Dangers of Short-Term Confinement: Indicators of Safety Risks Among Individuals in Jail

Guided by the premise that an individual's safety may be more at risk when their routines, personal attributes, or lack of guardianship influence their opportunity for exposure to violence, we examined the factors that influenced victimization risks and safety perceptions among a representative sample of respondents incarcerated at a large Midwestern jail. Results showed that vulnerable individuals such as those who were victimized prior to their incarceration, and those who antagonized others such as those who perpetrated assault, were threatened more often, were more at risk of assault victimization, and perceived more dangerous conditions. Conversely, females and individuals with greater self-control were less likely to have experienced victimization and generally felt safer in jail. Our results illustrate the importance of identifying and protecting individuals who might experience greater safety risks during jail incarceration and should be interpreted alongside research and policy aimed at improving safety and welfare within correctional institutions.

Introduction to Special Section: CSA Victimization in Incarcerated Populations

Research suggests that individuals involved in the criminal justice system have higher rates of childhood trauma, including experiences of child sexual abuse (CSA). Studies also suggest that childhood victimization has an impact on the success of mental health treatment for offenders which may contribute to recidivism rates. Accordingly, policymakers and correctional staff can be better informed in choosing appropriate assessments and intervention approaches when they understand the ways in which prior experiences of CSA impact individuals in correctional settings. This special section highlights four novel studies that advance the research examining CSA in incarcerated populations.

Therapeutic Outcomes of Treatment With Long-Acting Injectable Antipsychotics in Forensic Populations With Schizophrenia-Spectrum Diagnoses

The advantages of long-acting injectable antipsychotics (LAIs) in schizophrenia are well studied. However, forensic involvement is common in schizophrenia, and incarcerated individuals are often excluded from clinical trials. Nonadherence and oral medication diversion in forensic populations with schizophrenia, and the relationship between antipsychotic nonadherence and crime support LAI utilization in this subset of patients. Yet, federal regulations limit data generation in forensic populations. This review characterizes data on therapeutic outcomes of LAIs in correctional populations with schizophrenia-spectrum diagnoses. A search for primary literature was conducted in PubMed. Favorable effects of LAIs were observed on adherence, psychiatric symptomatology, patient satisfaction, health care costs, and frequency of criminal charges. Data were primarily retrospective and included small samples and individuals with historical versus current forensic involvement. Although limited, available literature and insights into the correctional system suggest advantages to LAI use in forensic populations. Barriers to conducting research in correctional settings must be addressed to facilitate further data generation.

The prevalence of substance use disorders among people in Norwegian, Danish and Swedish prisons: A multi-national cohort study, 2010-19

AIMS

We estimated the prevalence of substance use disorders (SUDs) in the Norwegian, Danish and Swedish prison populations and compared the prevalence of SUDs in the national prison populations with country-specific general population prevalence rates.

DESIGN

A multi-national cohort study using data from the National Prison Registries linked to the National Patient Registries in Norway, Denmark and Sweden.

SETTING AND PARTICIPANTS

We used data from the PriSUD-Nordic study, including national prison populations aged 19 years and older in Norway (2010-19), Denmark (2010-18) and Sweden (2010-13). A total of 119 507 Individuals (108 971 men and 10 536 women) contributing to 191 507 incarcerations were included in the study (Norway: 45432 men; 5429 women, Denmark: 42 162 men; 3370 women, Sweden: 21 377 men; 1737 women).

MEASUREMENT

We calculated a study prevalence and prevalence at entry to prison for all types of SUDs before imprisonment each consecutive year of observation in each prison population. We also extracted country-specific 1-year prevalence rates from the Global Burden of Diseases database to calculate comparative national prevalence ratios.

FINDINGS

The study prevalence of any SUD was approximately 40% [Norway: 44.0%, 95% confidence interval (CI) = 43.6-44.5%; Denmark: 39.9%, CI = 39.5-40.4%; Sweden: 39.1%, CI = 38.4-39.7%] in all three countries. Women had a significantly higher study prevalence of any SUD compared with men (Norway: 55.8 versus 42.6%, P < 0.001; Denmark 43.1 versus 39.7%, P = 0.004; Sweden: 51.7 versus 38.0%, P < 0.001). Prevalence estimates were higher for SUDs among people in prison than in the general population. We observed an increasing proportion of people with SUDs entering prison in Norway (P = 0.003), while the proportion was more stable in Denmark and Sweden.

CONCLUSIONS

Substance use disorders (SUDs) appear to be highly prevalent among the Scandinavian prison populations compared with the general population, especially among women. In Norway, there was a relative increase in SUDs from 2010 to 2019.

"Dying with a Smile, Just Knowing that Somebody's Listened to Me": End-Of-Life Care and Medical Assistance in Dying in Canadian Prisons

Medical assistance in dying (MAiD) has been legal in Canada since 2016 and some incarcerated patients who are at the end of their lives are eligible for the procedure. Interviews with nine incarcerated men at a federal penitentiary in Canada provide insight into some of the ways that people who are navigating aging and end-of-life in prison think about MAiD. Interview themes are organized around: experience with death and dying; possibilities and barriers related to applications for release from prison at end-of-life; experiences of peer-caregiving in a prison palliative care program; support for MAiD and the expansion of eligibility criteria; what a good death looks like. Themes are contextualized alongside federal guidelines related to end-of-life care (EOLC) and MAiD for prisoners, highlighting that sound policy requires both generalizable principles and attention to nuance. MAiD rests on patient voluntariness, and thus autonomy over EOLC decisions is paramount for prisoners.

Implementing Preexposure Prophylaxis for HIV Prevention in a Statewide Correctional System in the United States

HIV disproportionately affects populations experiencing incarceration. Preexposure prophylaxis (PrEP) is an effective approach to preventing HIV acquisition among populations at increased risk of acquiring HIV. Yet few, if any, efforts have been made to offer PrEP in correctional settings. Beginning in November 2019, the Rhode Island Department of Corrections (RIDOC) implemented a systemwide PrEP initiation program with linkage to PrEP care in the community upon reentry. Incarcerated individuals identified as being potentially at increased risk of HIV acquisition during standard clinical screenings and medical care were referred to a PrEP care provider for potential PrEP initiation. Of the 309 people who met with a PrEP care provider, 35% (n = 109; 88 men, 21 women) agreed to initiate PrEP while incarcerated. Clinical testing and evaluation were completed for 82% (n = 89; 69 men, 20 women) of those who agreed to initiate PrEP. Of those, 54% (n = 48; 29 men, 19 women) completed the necessary clinical evaluation to initiate PrEP, were determined to be appropriate candidates for PrEP use, and had the medication delivered to a RIDOC facility for initiation. Only 8 people (4 men, 4 women) were successfully linked to a PrEP care provider in the community after release. The RIDOC experience demonstrates notable levels of PrEP interest and moderate levels of PrEP uptake among this population. However, PrEP engagement in care after release and persistence in taking PrEP when in the community were relatively poor, indicating a need to better understand approaches to overcoming barriers to PrEP care in this unique setting.

Factors related to the severity of research misconduct administrative actions: An analysis of office of research integrity case summaries from 1993 to 2023

We extracted, coded, and analyzed data from 343 Office of Research Integrity (ORI) case summaries published in the Federal Register and other venues from May 1993 to July 2023 to test hypotheses concerning the relationship between the severity of ORI administrative actions and various demographic and institutional factors. We found that factors indicative of the severity of the respondent's misconduct or a pattern of misbehavior were associated with the severity of ORI administrative actions. Being required by ORI to retract or correct publications and aggravating factors, such as interfering with an investigation, were both positively associated with receiving a funding debarment and with receiving an administrative action longer than three years. Admitting one's guilt and being found to have committed plagiarism (only) were negatively associated with receiving a funding debarment but were neither positively nor negatively associated with receiving an administrative action longer than three years. Other factors, such as the respondent's race/ethnicity, gender, academic position, administrative position, or their institution's NIH funding level or extramural vs. intramural or foreign vs. US status, were neither positively nor negatively associated with the severity of administrative actions. Overall, our findings suggest that ORI has acted fairly when imposing administrative actions on respondents and has followed DHHS guidelines.

Estimates of Hepatitis C Seroprevalence and Viremia in State Prison Populations in the United States

BACKGROUND

Prior studies demonstrate that eliminating hepatitis C virus (HCV) in the United States (US) heavily depends on treating incarcerated persons. Knowing the scope of the carceral HCV epidemic by state will help guide national elimination efforts.

METHODS

Between 2019 and 2023, all state prison systems received surveys requesting data on hepatitis C antibody and viremic prevalence. We supplemented survey information with publicly available HCV data to corroborate responses and fill in data gaps.

RESULTS

Weighting HCV prevalence by state prison population size, we estimate that 15.2% of the US prison population is HCV seropositive and 8.7% is viremic; 54.9% of seropositive persons have detectable RNA. Applying prevalence estimates to the total prison population at year-end 2021, 91 090 persons with HCV infection resided in a state prison.

CONCLUSIONS

With updated and more complete HCV data from all 50 states, HCV prevalence in state prisons is nearly 9-fold higher than the US general population. The heterogeneity in HCV prevalence by state prison system may reflect variable exposure before arrest and/or differences in treatment availability during incarceration. Elimination of HCV in the country depends on addressing the carceral epidemic, and one of the first steps is understanding the size of the problem.

Retrospective review of rates of sexually transmitted and blood-borne infection (STBBI) testing in provincial corrections facilities in Newfoundland and Labrador

Background

Sexually transmitted and blood borne infection (STBBI) testing is recommended for people who are incarcerated (PWAI). We sought to determine the rate of STBBI testing during admissions to provincial correctional institutions in Newfoundland and Labrador (NL).

Methods

This retrospective cohort study collected the identification of all admissions records in provincial correctional facilities in NL between July 1, 2020 and June 31, 2021 using the Provincial Corrections Offender Maintenance System database. Admissions to provincial detention centers were excluded. Records were linked with STBBI results, when available, within the electronic medical record (Meditech) using demographics. Testing rates, STBBI positivity rates, and univariate analysis of predictors for STBBI testing were completed.

Results

Of the 1,824 admissions identified, 1,716 were available for linkage to laboratory results. Admissions to detention centers (n = 105) were excluded. Any STBBI test result was available for 72 (4.5%) of admissions. No admission had complete testing for all STBBI. Facility testing rates ranged from 1.9 to 11.2% and 37.5% of STBBI tests had any positive results. Sixteen out of the 21 (76.2%) hepatitis C virus (HCV) antibody positives received HCV RNA testing, and 11/16 (88.8%) were HCV RNA positive. Institution (p = 0.001) and sex (p = 0.004) were found to be significant predictors of STBBI testing, while age was not significant (p = 0.496).

Conclusions

STBBI testing rates were low in provincial correctional facilities in NL, and STBBI prevalence, especially for HCV, was high among those tested. Strategies to increase the rate of testing could contribute to STBBI control in corrections facilities.

Criminal Sexual Behavior of Individuals With Autism Spectrum Disorder and Recommendations for Correctional Professionals

Continued uncertainty on overrepresentation of autism spectrum disorder (ASD) in the criminal justice system (CJS), although important, has shifted focus away from other questions of CJS treatment of neurodiverse individuals and left little guidance on best practice for people with ASD. For ASD individuals involved in sex offenses, there remains even less guidance. Because aspects of ASD symptomatology can highly influence sexual behaviors in ways that differ from neurotypical sex offending, it is imperative that clinicians and correctional professionals know more about this potential influence of ASD on sex offending behaviors. This knowledge should then inform efforts to enact more effective and equitable policies when interacting with the ASD population. This article reviews the connection between ASD symptoms and sexual behaviors as well as the lack of ASD-oriented sex education that could result in sex offending charges. A review of literature examining sex offending risk and its relation to ASD follows. Recommendations for more equitable treatment are discussed for different aspects of the correctional system, including forensic assessment, treatment efforts, and correctional staff interactions.

Recommendations for the Use of Telepsychology in Psychology-Law Practice and Research: A Statement by American Psychology-Law Society (APA Division 41)

In response to the COVID-19 pandemic and subsequent impact on psychological work, Division 41 of the American Psychological Association convened a taskforce to provide guidance to its membership regarding the use of technology for practice and research at the intersection of psychology and law. Drawing from existing research in psychology-law and beyond, as well as the first-hand experience of taskforce members, this document outlines foundational guidance to apply technology to forensic and correctional work while acknowledging these settings provide unique challenges to ethical practice. The recommendations provide support for psychologists involved in assessment, treatment, training, and research. However, these recommendations may not exhaustively apply to all areas of psycholegal practice or all forms of technology. Further, these recommendations are intended to be consulted in conjunction with other professional practice guidelines, emerging research, and policy changes that impact the integration of technologies into this work.

Betting Against the Odds: The Mysterious Case of the Clinical Override in Risk Assessment of Adult Convicted Offenders

Various tools were designed to guide practitioners in the risk assessment of offenders, including the Level of Service and Case Management Inventory (LS/CMI). This instrument is based on risk assessment principles prioritizing the actuarial approach to clinical judgment. However, the tool's architects allowed subjective judgment from the practitioners-referred to as clinical override-to modify an offender's risk category under certain circumstances. Few studies, however, have examined these circumstances. Therefore, the current study used decision tree analyses among a quasi-population of Quebec offenders (n = 15,744) to identify whether there are offenders more likely to be subjected to this discretion based on their characteristics. The results suggest that, although the override is rare, it occurred under few specific combinations of circumstances. More precisely, these findings propose that the utilization of the clinical override stems from a perceived discrepancy between risk prediction and management.

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.

Drug Addiction and Incarceration: A Call for Research and Transparency Among Prison-Based Substance Abuse Treatment Programs

As drug-related offense and illicit drug overdose rates continue to grow in the United States, criminologists have begun to pay more attention to factors influencing illicit drug use as well as effective methods of promoting drug abstinence in treatment programs across the nation. Although much scholarly attention is given to community-based substance abuse treatment programs, a considerably smaller focus of research is devoted to substance abuse treatment programs that are prison-based. Moreover, some of the most effective methods of treating inmates who are addicted to an illicit drug (such as Cognitive Behavioral Therapy, Therapeutic Community, etc.), although praised for their initiative and theoretical effectiveness, are often demonstrated via individualized empirical study that the expected advantages of such programmatic forms of treatment fail to emerge. The present study explores what scholars have discovered regarding the effectiveness of prison-based substance abuse treatment programs, how such findings appear to contradict one another, and why state prison systems should be more transparent regarding their in-house drug treatment programs in their publicly accessible reports that are formulated into cumulative reports on each states' Bureau of Corrections websites.

Prevalence of Psychiatric Disorders by Demographics in Jail Populations

Many individuals incarcerated in jails suffer from psychiatric disorders and require mental health treatment. However, there has yet to be a study which comprehensively described the prevalence of mental illness diagnoses by demographic variables or compared results to the general population. Data for this study were the Survey of Inmates in Local Jails, 2002. Binary logistic regression was run to compare the prevalence of diagnoses to demographic variables of the jail population. Results were compared to studies in the general population. Males were less likely than females to report five of the seven disorder categories, and employed individuals were less likely to report all seven disorders. The results were consistent with research on the general population. It is important to understand the population of individuals with mental illness in jail so we can better serve them and catch psychiatric disorders early while they are more easily treatable.

Aboriginal and Torres Strait Islander perspectives on forensic risk assessment

Risk assessment instruments are used to estimate risk of recidivism and aid in decision-making and treatment planning. However, many of these instruments, including the Level of Service/Risk, Need, Responsivity (LS/RNR), are validated on predominantly Western populations, and research has questioned whether the factors included in the LS/RNR adequately capture the experiences and needs of non-Western communities, including Aboriginal and Torres Strait Islanders. The current study aimed to canvas the opinions of Aboriginal and Torres Strait Islander community justice workers as to the suitability of the LS/RNR for use with this population. A general qualitative methodology was adopted to gain in-depth information through the facilitation of a focus group, and data were analysed thematically. Whilst participants agreed that the LS/RNR risk factors are relevant to Aboriginal and Torres Strait Islander offenders, they reported that the instrument did not adequately capture relevant culturally specific considerations and made suggestions to improve the LS/RNR.

Evaluation of Correctional Facility COVID-19 Outbreaks With Layered Mitigation Strategies Including Vaccination: Colorado, 2020-2021

In 2020-2021, a Colorado corrections facility experienced four COVID-19 outbreaks. Case counts, attack rates (ARs) in people who are detained or incarcerated (PDI), and mitigation measures used in each outbreak were compared to evaluate effects of combined strategies. Serial PCR testing, isolation/quarantine, and masking were implemented in outbreak 1. Daily staff antigen testing began in outbreak 2. Facility-wide COVID-19 vaccination started in outbreak 3 and coverage increased by the end of outbreak 4 (PDI: <1% to 59%, staff: 27% to 40%). Despite detection of variants of concern, outbreaks 3 and 4 had 97% lower PDI ARs (both 1%) than outbreak 2 (29%). Daily staff testing and increasing vaccination coverage, with other outbreak mitigation strategies, are important to reduce COVID-19 transmission in congregate settings.

Anxiety Among Correctional/Detention Health Professionals and Associated Risk Factors During the Coronavirus Disease 2019 Pandemic

Correctional health professionals are vulnerable to the negative mental health outcomes associated with the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional survey was conducted to assess anxiety symptoms in health professionals who work in correctional/detention facilities and identify associated risk factors. Data were collected from 192 health professionals from March 23 to June 30, 2021. The prevalence and degree of anxiety symptoms were assessed by the Generalized Anxiety Disorder (GAD) scale. Chi square, Mann-Whitney U, and Pearson's correlation were used to assess the associations among anxiety scores and demographic data, COVID-19 exposures, medical and psychological history, and isolation practices. Of the sample, 27.1% had at least moderate levels of anxiety (GAD-7 score >10), which is highly suggestive of a diagnosis for GAD. Main factors associated with higher levels of anxiety included female gender, younger age, type of facility, less access to personal protective equipment, and a history of chronic medical problems. The psychological burden of COVID-19 on correctional/detention health professionals is significant, and behavioral health interventions should be considered for this unique population.

Therapeutic Interventions for Mental Wellness in Correctional Facilities: A Systematic Review

The article includes a systematic review of therapeutic interventions being used to improve mental health of males and females incarcerated in U.S. jails and prisons. Using pertinent keywords, we searched the following databases: SocINDEX, CINAHL Complete, Medline Complete, PsychINFO, Psychology and Behavioral Sciences Collection, and Criminal Justice Abstracts with Full Text for studies published between 2010 and 2021. The initial search yielded 9,622 articles. After screening, 28 articles met the inclusion criteria and were reviewed. Review indicated use of a diverse range of interventions to address mental health outcomes including, but not limited to, PTSD, depression, and anxiety. A few studies did not focus on specific mental health outcomes, but rather on behavioral outcomes such as distress, affect, mood, time spent in the hospital, number of acts of self-injury, competency restoration, and wellbeing of the participants. The review includes implications for future research and practice.

Characterizing Arrest and Incarceration in a Prospective Cohort of Transgender Women

This study characterized arrest, incarceration, and risk factors for incident incarceration among transgender women (TW) in the northeastern and southern United States. During semiannual study visits over 24 months in a multicenter cohort study, TW completed HIV testing and self-administered surveys. In total, 1571 TW completed baseline survey; 1,312 HIV-negative TW enrolled in the cohort and contributed 2134.3 person-years to the analysis. At baseline, 37% had been arrested and 21% had been incarcerated. Incident incarceration was 23.4 per 1,000 person-years (95% confidence interval [CI]: 16.9-29.9). Sex work was significantly associated with baseline and incident incarceration (p < .01). A history of incarceration at enrollment was the strongest predictor of incident incarceration (adjusted odds ratio [aOR] 6.99; 95% CI: 3.43-14.24). Living in the South (aOR 2.69, 95% CI: 1.22-5.93), income below the federal poverty level (aOR 2.65 95% CI: 3.43-14.24), and having a recent partner who had been incarcerated (aOR 2.62, 95% CI: 1.20-5.69) also increased the odds of incident incarceration in multivariable modeling. Structural interventions to reduce poverty and decriminalize sex work have the potential to reduce incarceration rates among TW.

Believing and sharing misinformation, fact-checks, and accurate information on social media: The role of anxiety during COVID-19

The COVID-19 pandemic went hand in hand with what some have called a "(mis)infodemic" about the virus on social media. Drawing on partisan motivated reasoning and partisan selective sharing, this study examines the influence of political viewpoints, anxiety, and the interactions of the two on believing and willingness to share false, corrective, and accurate claims about COVID-19 on social media. A large-scale 2 (emotion: anxiety vs relaxation) × 2 (slant of news outlet: MSNBC vs Fox News) experimental design with 719 US participants shows that anxiety is a driving factor in belief in and willingness to share claims of any type. Especially for Republicans, a state of heightened anxiety leads them to believe and share more claims. Our findings expand research on partisan motivated reasoning and selective sharing in online settings, and enhance the understanding of how anxiety shapes individuals' processing of risk-related claims in issue contexts with high uncertainty.

Amending the literature through version control

The ideal of self-correction in science is not well served by the current culture and system surrounding amendments to published literature. Here we describe our view of how amendments could and should work by drawing on the idea of an author-led version control system. We report a survey (n = 132) that highlights academics' dissatisfaction with the status quo and their support for such an alternative approach. Authors would include a link in their published manuscripts to an updatable website (e.g. a GitHub repository) that could be disseminated in the event of any amendment. Such a system is already in place for computer code and requires nothing but buy-in from the scientific community-a community that is already evolving towards open science frameworks. This would remove a number of frictions that discourage amendments leading to an improved scientific literature and a healthier academic climate.

Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada

Introduction

Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada.

Methods

This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants’ release. Data were thematically analyzed.

Results

The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of ‘take-home’ OAT medications were common barriers.

Conclusions

Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options.

Intervention for Firesetting Offenders: A Case Study

There is little research on treatment for firesetting, especially for those who were incarcerated for their offenses. Of the treatment programs that do exist, there are limitations to feasibly implementing these in correctional settings. We propose a short-term (eight-session) program, Intervention for Firesetting Offenses (INFO), based on techniques that have been empirically supported for this population, including psychoeducation, motivational interviewing, cognitive behavioral therapy-based strategies, and relapse prevention. We provide a description of INFO using the case study of Mr. A, a man who was incarcerated for an arson offense. Overall, INFO was feasibly and effectively implemented, as the individual improved his understanding of firesetting in general and his own motivations and risk factors for engaging in firesetting and developed a relapse prevention plan to avoid future offending behaviors.

Burnout among Professionals Working in Corrections: A Two Stage Review

Burnout is a state of emotional, physical, and mental exhaustion often caused by excessive and prolonged stress. Given the emotionally and often physically demanding nature of the work of correctional professionals, they are at substantial risk of suffering the adverse consequences of burnout. We systematically reviewed (Stage 1) the influence of burnout amongst forensic psychologists, psychiatrists, case workers, nurses, and correction officers. Interventions were then reviewed (Stage 2) at the individual and collective level to examine the effectiveness or efficacy of treatments for burnout among professionals working in corrections.

A Content Analysis of Prison Websites: Exploring Approaches to Rehabilitation in Latin America

Across much of Latin America, prison systems are characterized as having significantly high incarceration and overcrowding rates. In recent years, some of these systems have sought to address such problems by implementing rehabilitation and early release programs. However, the extent to which rehabilitation has been embraced and the nature of said efforts is not known. Using content analysis methods, this exploratory study examines the existence of language supporting rehabilitative practices and goals on official prison system websites across the region. While our findings suggest that prison systems have largely embraced rehabilitative goals, there is limited evidence to indicate that evidence-based practices are emphasized when it comes to assessment and correctional programs. As countries embrace rehabilitative efforts, it is important that they use empirically supported practices, as a perceived failure of the rehabilitative approach could shift the pendulum away from treatment and toward punishment. Implications for future research are discussed.

Differentiating Sexual From Other Violent Offence Types for Case Assessment, Planning, and Management

Core components of the Intake Assessment (IA) process in the Canadian federal corrections system were examined to determine whether a simplified algorithmic equation for individuals sentenced for sex crimes could be tailored and differentiated from other violent offence types. Two major offence type categories, namely sexual and other violent were constructed for 2,896 adult male first releases for 2016 to 2017 and 2017 to 2018. A restricted set of static risk indicators, dynamic need ratings, and other actuarial measures as well as whether or not there were any returns to federal custody were extracted for each case. A combined risk index yielded robust predictions of custodial return for sexual and other violent offence types with significant and robust AUCs of 0.77 and 0.71, respectively. Analyses showed that five-level risk groupings could be derived independently for the two offence type categorizations.

Conditional release and cannabis use: Concerns and challenges for community reintegration

This article, which serves as a perspective review, delves into the complexities of cannabis use among individuals preparing for or already on conditional release (CR). These complexities include an association between cannabis use and mental illness and dealing with the fact that the use of illicit substances, such as cannabis, is against CR rules, leading to potential revocation. A focus of this article is the deleterious effects cannabis and synthetic derivatives of cannabis can have for individuals on CR. The article concludes with six-specific recommendations for managing cannabis use in this population with a focus on careful and detailed risk assessments that considers the relationship between substance use and dangerousness, the role of protective factors, the need for a detailed conditional release plan, inpatient and community-based interventions aimed at increasing individual autonomy, and education on the dangers of cannabis use for both the treatment team and the insanity acquittee.

Substance use-related suicide after release from correctional, behavioral health, and healthcare facilities using national violent death reporting system data

INTRODUCTION

Suicide and substance use are prevalent problems among persons discharged from facilities. This study (1) articulated rates of substance-related suicide deaths among those discharged correctional, behavioral health, and healthcare facilities, and (2) identified factors associated with substance-related suicide deaths unique to, or generalizing across, facility discharge.

METHODS

We used data from the National Violent Death Reporting System. Suicide deaths (N = 105,968) were aggregated from 2003 to 2017. Chi-square and independent samples t-tests were used to examine associations between drug/alcohol-related deaths and each correlate. Logistic regression was employed to identify the most robust substance-related suicide death-related factors.

RESULTS

Suicide deaths were commonly marked as being substance-related: 69% from correctional institutions, 54% from behavioral health facilities, 45% from those not released from a facility, and 39% from healthcare facilities. Regression models indicated housing interruptions and interpersonal stressors increased odds of the suicide death being marked as substance-related across discharge categories. Each discharge category also had unique predictors, underscoring the need for tailored prevention.

CONCLUSIONS

Substance-related suicide deaths are particularly common among adults discharged from correctional and behavioral health facilities. Findings are discussed with respect to community-focused, discharge planning, and clinical care suicide prevention strategies.

A Comparison Between Rural and Urban Jail Proximities to Inpatient Mental Health Care in New York State

The authors created a model to examine the distance between jails and inpatient mental health care facilities in rural counties versus urban counties in New York State. Using U.S. census data, the top seven most rural counties and top seven most urban counties were selected for analysis. Results indicate that, overall, urban jails have closer access than rural jails to inpatient mental health care, with the furthest facilities for urban jails being 15.1 kilometers and the furthest for rural jails being 43.6 kilometers. The closest inpatient mental health care facility for urban jails was 174 meters, whereas the closest mental health care facility for rural jails was 0.02 kilometers. Average distance from inpatient mental health care was 4.3 kilometers for urban jails and 26 kilometers for rural jails. Policy implications are discussed.

Medical Assistance in Dying (MAiD) for Canadian Prisoners: A Case Series of Barriers to Care in Completed MAiD Deaths

Background: As of August 2020, 11 patients who were federally incarcerated in a Canadian prison requested medical assistance in dying (MAiD), and three received it. This case study seeks to understand the process of care as described by physicians involved in each of the cases that resulted in MAiD. Methods: During the summer of 2020, semistructured interviews were conducted with physicians involved in each known Correctional Service of Canada (CSC) MAiD case. Transcripts were summarized to illuminate details of the care process for each patient, highlighting barriers to patient-centered care. Results: Each case took place in a different province. One MAiD provision took place in a prison hospital, and two provisions took place after the incarcerated patients were transferred to external community hospitals. Case summaries highlight the physicians' efforts and challenges in assuring patient-centered care. Discussion: Physician experiences illuminate several barriers to care: CSC bureaucratic processes that forced longer wait times than typical for patients in the general public; challenges related to accessing release before MAiD application; knowledge of patient preference for location of death; concerns of voluntariness and confidentiality that are unique to CSC patients; and ethical considerations surrounding the presence of prison guards, police officers, and shackles at the time of assessment or provision. Reporting by the Office of the Correctional Investigator highlights additional challenges in these cases. Further inquiry is necessary to include the perspectives of prisoners and prison staff, and to consider how the evolution of new MAiD legislation will affect MAiD for prisoners.

Effect of Clozapine on Time Assigned to Restrictive Housing in a State Prison Population

This study examined the effect of clozapine on time assigned to restrictive housing (RH; i.e., solitary confinement), disciplinary infractions, and assaults on custody staff among patients treated within the North Carolina prison system. Records were reviewed for patients initiated on clozapine (n = 84) over a 3.5-year period. Fifty-nine patients completed at least three consecutive months of treatment and were included in data analysis. Assigned RH days and disciplinary infractions were assessed for the periods prior to and after treatment with clozapine. Patients accumulated 13,500 RH days pretreatment and 3,560 days postclozapine initiation. There was a significant reduction in RH days with clozapine treatment (P < .05). Patients with personality disorders (n = 36) had a significant decrease in RH days (P < .05), while those with psychotic disorders (n = 23) showed a decrease with borderline significance (P = .051). There were 253 disciplinary infractions pretreatment, including 27 assaults on custody staff, and 118 infractions posttreatment, including 7 assaults; the decrease in infractions was significant in the first three months of treatment (P < .05). The mean ± SD duration of treatment was 269 ± 102 days. Expanding clozapine use in state prisons should be a high priority, as these data are consistent with reports of clozapine's benefits in community settings.

Multiple scattering and resolution effects in small-angle neutron scattering experiments calculated and corrected by the software package MuScatt

This article deals with multiple scattering effects that are important for the method of small-angle neutron scattering (SANS). It considers three channels for the coherent elastic, the incoherent elastic and the incoherent inelastic scattering processes. The first channel contains the desired information on the experiment. Its multiple scattering effects can be desmeared, as shown in the later sections of the article. The other two channels display a nearly constant background as a function of the scattering angle. The incoherent elastic scattering is treated by the theory of Chandrasekhar, allowing for multiple scattering even at large scattering angles. The transfer to a single representative thermalized wavelength by the inelastic scattering - as a simplification - is assumed to happen by a single scattering event. Once the transition to this altered wavelength has happened, further incoherent multiple scattering is considered. The first part of the paper deals with the multiple scattering effects of light water. In the later part of the article, deconvolution algorithms for multiple scattering and instrumental resolution of the elastic coherent signal as implemented in the program MuScatt are described. All of these considerations are interesting for both reactor-based instruments with velocity selectors and time-of-flight SANS instruments and may improve the reliability of the data treatment.

Abjection and the weaponization of bodily excretions in forensic psychiatry settings: A poststructural reflection

Nurses working in forensic psychiatric settings face unique challenges in practice, where they take on a dual role of custody and caring. Patient resistance is widespread within these restrictive settings and can take many forms. Perhaps the most disturbing form of resistance entails a patient's weaponization of their bodily fluids, with nurses as their target. The tendency in assigning motive for this act is to relegate to the psychopathology of the patient. This paper will adopt a poststructuralist perspective to reexamine this phenomenon as an act of resistance through the lens of Kristeva's concept of abjection. Patients confined in these settings have little sense of control, and in resistance may resort to the only thing available: their bodily fluids. By weaponizing the abject, patients actively violate and permeate the physical and psychological boundaries of nurses-the very boundaries considered crucial to safe and professional forensic psychiatric nursing practice. By recognizing this phenomenon as an act of resistance to confinement and loss of control, nurses may reorient their approach to care in forensic psychiatric settings.

Pharmacological interventions for alcohol misuse in correctional settings: A systematic review

BACKGROUND

The prevalence of alcohol use disorder (AUD) is estimated to be 10 times higher amongst individuals in the criminal justice system than the general population. Alcohol use is also one of the strongest modifiable risk factors for recidivism. One intervention that has been shown to be effective in reducing alcohol consumption in the general population is medication-assisted treatment (MAT), and this systematic review synthesized the existing evidence on MAT for AUD in correctional settings.

METHODS

Empirical, peer-reviewed studies on approved medications for AUD in correctional populations were searched in major databases. One hundred sixty-two articles were initially screened and 14 eligible articles were included in the final review. Four articles examined disulfiram, and 10 articles examined naltrexone.

RESULTS

The studies on disulfiram were considerably older than those on naltrexone, predating contemporary scientific standards. Disulfiram in combination with substantial contingencies in a supervised setting significantly reduced alcohol-related measures of consumption and recidivism and had acceptable safety and tolerability. All naltrexone studies showed significant reductions in alcohol-related measures, but effects on recidivism were mixed. The naltrexone studies indicated that it was highly acceptable and well tolerated. In addition, offenders receiving naltrexone had significantly greater medication adherence, treatment attendance, and treatment duration than with placebo.

CONCLUSIONS

A small number of studies on pharmacological interventions for AUD in the correctional population suggest that MAT is effective in reducing alcohol consumption, although results on recidivism are mixed. On balance, the evidence was more supportive of naltrexone in reducing alcohol-related outcomes than disulfiram and it may also be a more feasible intervention in correctional settings. Further research on MAT to address AUD in correctional populations with larger sample sizes, longer duration, and in combination with behavioral interventions is warranted.

A Pilot TB Screening Model in a U.S. Prison Population Using Tuberculin Skin Test and Interferon Gamma Release Assay Based on Country of Origin

The objective of this study was to compare tuberculosis (TB) screening results before and after implementation of a stratified testing strategy screening pilot study, incorporating interferon gamma release assay (IGRA) and tuberculin skin test (TST), based on country of origin. In 2015, the Washington State Department of Corrections began screening people born outside of the United States for TB with IGRA, while U.S.-born people continued screening by TST. Of 405 (75%) foreign-born men screened with IGRA, 403 had valid test results and IGRA screening positivity was 10.4% (N = 42). In contrast, among 5,940 primarily U.S-born men screened with TST, 24 (0.4%) were positive. Overall positivity was 1.05%, similar to TST-only positivity in 2013 (1.05%) and 2014 (0.85%). Incorporating IGRA screening among foreign-born persons was feasible in this state prison system.

Who Are the Compliant Correctional Clients? New Evidence on Protective Factors among Federal Supervised Releases

Protective factors facilitate success on community supervision, but relatively little is known about correctional clients who are highly compliant particularly in the federal system. Drawing on a near population of federal clients on supervised release in the Midwestern United States, the current study examined variables associated with compliant supervision status. One day on supervision contributed to a 1% reduction in the logged odds of supervision compliance. Clients with no drug history had 793% increased odds, clients with sustained remission had 620% increased odds, and clients with early remission had 458% increased odds of compliant supervision status relative to clients actively using drugs. Among the federal Post Conviction Risk Assessment (PCRA) indices, only PCRA Criminal History was significant as clients with less extensive criminal history were more likely to be compliant supervision clients. A one-unit change in PCRA Criminal History status was associated with 25% reduced odds of supervision compliance. Total conditions were inversely associated with compliant supervision status with each additional condition associated with a 19% reduced likelihood of compliant supervision status. None of the demographic variables was significantly associated with compliant supervision status. Implications of the findings for the protective factor paradigm in corrections are discussed.

Interpersonal Violence and Institutional Misconduct in the Los Angeles County Jail System: A Mixed Method Investigation

This study involved a mixed method evaluation of interpersonal violence and institutional misconduct in the Los Angeles county jail system. Interviews with 52 correctional staff uncovered a widely shared belief that AB 109, Prop 47, and the Rosas decision had all contributed to an increase in violence and misconduct in the jail. Analysis of administrative records indicated there was a rise in the monthly rates of these adverse outcomes from 2010 to 2017. Intervention ARIMA models, however, revealed evidence of a statistically significant increase following only the passage of Prop 47. An examination of inmate characteristics across the 8-year observation period confirmed staff suspicions that jail incarcerates with more extensive criminal histories were being confined following the passage of these policies. If jails are to be responsible for confining higher risk inmates, provisions should also be made to increase the availability of evidence-based rehabilitative programming and other treatment services that can help combat the occurrence of these adverse outcomes.

Enhancing Mental Health Treatment for Borderline Personality Disorder in Corrections

Improving mental health among inmates has been a long-term challenge for correctional systems. Although borderline personality disorder (BPD) has garnered limited attention in the literature, evidence suggests it is highly prevalent in corrections. It is important to provide comprehensive treatment for this condition, given its high prevalence and significant personal, societal, and economic burden. This article discusses two approaches aimed at enhancing mental health treatment for BPD in corrections. The first focuses on implementing evidence-based psychotherapy that is customized to the correctional setting. The other approach is expanding telemental health to overcome clinician shortages and maintain high-quality care.

Mischief, Mayhem, and Remediation

Institutional rules are necessary to preserve safety and security in correctional systems. An assessment of relevant mental health problems is a key element of a fair disciplinary process. Though these hearings are administrative in nature, we recommend that mental health evaluations related to disciplinary matters be completed by qualified and well-trained professionals using consistent standards. There are important opportunities to interrupt an untreated mental illness by identifying mental health problems during such evaluations and making appropriate referrals for treatment. We propose the use of intrafacility diversionary programs for drug offenses and other misconduct.

Trauma-Informed Care: The Importance of Understanding the Incarcerated Women

Numerous studies and research substantiate strong correlations between adverse childhood experience (ACE) scores and corrections. This study assessed the significance of trauma-informed care (TIC) in the recidivism rates of incarcerated women. A retrospective longitudinal survey was conducted. ACE scores were evaluated and documented through a self-reported survey. Seven years of Correctional Offender Management Profiling for Alternative Sanctions registry documentation was assessed. Descriptive statistics were utilized to define patients and evaluate patterns of recidivism after implementation of trauma-informed approaches to care. There is strong evidence associating lower recidivism rates for those who participate in TIC and trauma programs than for those who do not. This evidence supports further evaluation with a serious potential impact of reduction in recidivism and improved trajectories for incarcerated women and their families.

Compassion in Corrections: The Struggle Between Security and Health Care

Many incarcerated individuals have chronic health conditions and mental health issues that have not been addressed by health care providers in years, if not decades. Patients in correctional settings are isolated from society and have reduced access to health care. Prison is a lonely scary place. How then do nurses impact the lives of these patients? It can be challenging given safety concerns, resource issues, and the bias of not only the nurse but also the security staff with whom they are working. Nurses have a responsibility to their patients to beneficence, justice, nonmaleficence, and autonomy. Compassion in corrections, though, is often viewed as naivete or weakness. Should these qualities be left out of corrections? By identifying one's own bias and asserting firm consistent practices, correctional nurses can set an example of unbiased care. The standards of care are the minimum required, but are they enough?

Impact of a Total Worker Health® Mentoring Program in a Correctional Workforce

(1) Background: Correctional Officers show signs of adverse health early in their careers. We evaluated the impact of a one-year peer health mentoring program for new officers based on a Total Worker Health® approach; (2) Methods: Cadets (n = 269) were randomly assigned to a mentored or control group. Cadets in this mixed methods design completed physical assessments, and surveys at three time points to assess demographics, health, mentoring, and workplace variables. Physical testing included several health markers. Surveys and physical data were analyzed as repeated measures. Regression analyses were used to analyze the relationship between mentoring characteristics and outcomes. A semi-structured interview of mentors was analyzed qualitatively. (3) Results: Higher mentoring frequency was associated with lower burnout. Health behaviors and outcomes declined over time in all groups, but mentees displayed slower decline for body mass index (BMI) and hypertension compared to controls. (4) Conclusions: A continuous peer health mentoring program seemed protective to new officers in reducing burnout and also declines in BMI and hypertension. Short-term physical health markers in younger officers may not be an index of psycho-social effects. A participatory design approach is recommended for a long-term health mentoring program to be both effective and sustainable.

Implementing a Culture of Health Among Probationers

Justice-involved individuals struggle with a multitude of health issues, and addressing the needs of these individuals requires the efforts of multiple agencies working across traditionally siloed systems. This study provides evidence on the implementation of a one-stop health services delivery model, Culture of Health, piloted in an urban probation office. This model uses a change team approach to focus the efforts of multiple agencies toward improving the alignment, collaboration, and synergy of health and other social service delivery to this underserved population. This article reports on the development and application issues involved in instituting such a novel design. The study demonstrates that the health culture within probation, buy-in from probation officers, and dwindling support from change team members all posed noteworthy issues for program implementation.

Leadership in Correctional Nursing: The First Step

Correctional nurses fulfill many roles in the provision of health care to incarcerated individuals. The role most readily visible is health care provider, but today's nurses are also expected to fill a variety of different leadership roles. Leadership is recognized as a fundamental characteristic of nursing by the nursing organizations that set professional standards. Possessing leadership skills is thus vital to the professional correctional nurse. The first step in developing leadership skills requires introspection and contemplation. Today's nursing leaders must understand and express their core values and beliefs if they want to establish and enhance their credibility. This article explores personal inspiration and motivation and guides nurses through the process of articulating their beliefs and values to their constituents in the form of a Personal Professional Philosophy Statement.

Patterns and Predictors of Reincarceration among Prisoners with Serious Mental Illness: A Cohort Study: Modèles et prédicteurs de réincarcération chez les prisonniers souffrant de maladie mentale grave : Une étude de cohorte

BACKGROUND

A small proportion of people who have serious mental illness and rapid and frequent incarcerations account for a disproportionate amount of overall service use and cost. It is important to describe such individuals, so that services can respond more effectively.

METHODS

We investigated a cohort of 4,704 incarcerated men and women who were discharged from a correctional mental health service and followed for a median of 535 days. We investigated social, clinical, demographic, and offense characteristics as predictors of return to the service using Cox survival analyses. Secondly, we characterized individuals as high-frequency service users as those who had 3 or more incarcerations during a 1-year period and investigated their characteristics.

RESULTS

We found that a higher rate of return to custody was associated with schizophrenia spectrum/bipolar affective disorder (BPAD), personality disorder traits, crack cocaine and methamphetamine use, and unstable housing. Charges of theft/robbery and breach of probation were also positively associated, and sex assault was negatively associated with return to custody. Within a 1-year time period, we found 7.2% of individuals were high-frequency service users, which accounted for 19.5% of all reincarcerations.

CONCLUSION

Identification of the characteristics of those with mental illness in custody, especially those who have high-frequency returns to custody, may provide opportunity to target resources more effectively. The primary targets of intervention would be to treat those with schizophrenia/BPAD and substance use problems, particularly those using stimulants, and addressing homelessness. This could reduce the problem of repeated criminalization of the mentally ill and reduce the overall incarceration rate.

Release or Denial: Evaluating the Roles of Emotion and Risk in Parole Decisions

Parole boards often incorporate numerous factors when making release decisions. These factors are typically related to the inmates' case files. However, in some instances, parole boards' decisions are influenced by factors outside of the case files, sometimes referred to as extra-legal factors. According to the emotion as social information model, emotion can communicate specific messages to others, and in this case, parole board members might unknowingly incorporate their own emotions and inmates' emotional displays into their decisions. The current study examines the role of parole board member and inmate emotional expressions as predictors of parole release decisions. Parole hearings were coded for emotion, parole board and inmate gender, supporter presence, and risk scores. Overall, risk scores and parole board members' emotions predicted release decisions. Higher risk scores were associated with a lower likelihood of release, and inmates' negative emotion was related to a lower likelihood of release. Implications are discussed.

Why Are Workplace Social Support Programs Not Improving the Mental Health of Canadian Correctional Officers? An Examination of the Theoretical Concepts Underpinning Support

In Canada, public safety personnel, including correctional officers, experience high rates of mental health problems. Correctional officers' occupational stress has been characterized as insidious and chronic due to multiple and unpredictable occupational risk factors such as violence, unsupportive colleagues and management, poor prison conditions, and shift work. Given the increased risk of adverse mental health outcomes associated with operational stressors, organizational programs have been developed to provide correctional officers with support to promote mental well-being and to provide mental health interventions that incorporate recovery and reduction in relapse risk. This paper uses two theories, the Job Demand Control Support (JDCS) Model and Social Ecological Model (SEM), to explore why workplace social support programs may not been successful in terms of uptake or effectiveness among correctional officers in Canada. We suggest that structural policy changes implemented in the past 15 years have had unintentional impacts on working conditions that increase correctional officer workload and decrease tangible resources to deal with an increasingly complex prison population. Notably, we believe interpersonal support programs may only have limited success if implemented without addressing the multilevel factors creating conditions of job strain.

Barriers to the Adoption of Technological Innovations in Corrections: A Review and Case Study

Over 600,000 criminal justice involved individuals are released from state and federal prisons each year, and close to 5,000,000 former offenders are placed under some form of community-based supervision. Access to services that may facilitate the reentry process is complicated and more often than not, returning citizens have significant and wide-ranging needs left unaddressed that require a comprehensive approach. In the current paper, we discuss the adoption and implementation processes of technological innovations noted in the criminal justice and correctional literature, as well as other disciplines, while using examples and lessons learned from a pilot project evaluating a new technology known as Pokket, which is a cloud-based service aimed at improving the re-entry process for returning citizens, service providers, and criminal justice agencies.