Correctional Health Care

This article reviews the literature concerning self-injury among criminal offenders. It describes many of the problems, barriers, and obstacles to effective assessment and treatment of self-injury and discusses the absence of a clear paradigm within which to develop a classification system and standardized nomenclature to describe the spectrum of self-injurious behaviors. This article distinguishes between self-injury resulting from suicidal versus nonsuicidal intent, presents treatment strategies for managing each, and concludes with a proposed set of eight recommended goals for creating a national strategy to develop self-injury programming in correctional settings.

This study profiled 2,913 adults aged 50 and older sentenced to a statewide correctional system and their parole eligibility status with implications for community reintegration, resettlement, and recovery needs. The research team developed the Correctional Tracking Data Extraction Tool to gather official data and personal and legal characteristics from a state department of corrections website. The majority of older prisoners were men from racial/ethnic minorities between the ages of 50 and 59 with a range of minor to serious offenses. Time served in prison ranged from 1 month to 45 years; more than 40% were eligible for parole within 5 years. These findings underscore the need for an intervention that can address the differing typologies and individual-level and systemic issues that gave rise to the aging prisoner population. Promising practices that address elements of a conceptual model in prison and community reintegration and recovery for older adult prisoners are reviewed.

This case study presents a 37-year-old male who was experiencing excited delirium (ExD) and died in a county jail 4 days after being taken into custody. The male died in a jail observation cell without having been restrained and was not under the influence of a drug stimulant. The subject had a documented psychiatric history of bipolar disorder and schizophrenia and was known to consume marijuana, cocaine, and methamphetamines. This case illustrates the pernicious effects of ExD and how its lethality can be delayed when many cases involve drug use and use of force where subjects die shortly thereafter. Implications of ExD for correctional agencies and efforts of responding to it in correctional and law enforcement contexts are discussed.

Despite falling crime rates in England and Wales over the past 20 years, the number of prisoners has doubled. People over the age of 50 constitute the fastest growing section of the prison population, and increasing numbers of older prisoners are dying in custody. This article discusses some of the issues raised by these changing demographics and draws on preliminary findings from a study underway in North West England. It describes the context behind the rise in the numbers of older prisoners; explores the particular needs of this growing population; and discusses some of the practical and emotional challenges for prison officers, health care staff, and fellow prisoners who are involved in caring for dying prisoners in a custodial environment.

The Italian Ministry of Justice and that of Health have established two strategies to limit the spread of COVID-19 in prisons: progressive isolation from the external world and adoption of practices to identify possible cases and to treat infected subjects. After the announcement of regulations revolts erupted in numerous Italian prisons. The motivations and effects of these strategy are discussed critically into the search for a balance between the right to health and other rights of prisoners in Italian prisons with the problem of an occupancy level of 121.75%.

More than half of the state prisons in the United States outsource health care. While most states contract with private companies, a small number of states have reached out to their health science universities to meet their needs for health care of prisoners. New Jersey is the most recent state to form such an agreement. This article discusses the benefits of such a model for New Jersey's Department of Corrections and for New Jersey's health sciences university, the Rutgers University, formerly the University of Medicine and Dentistry of New Jersey. The benefits for both institutions should encourage other states to participate in such affiliations.

HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of correctional agency partners from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) revealed that HIV policies and practices in prevention, detection, and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery ...

Juvenile drug court (JDC) offenders have benefited from evidence-based interventions addressing antisocial behavior, mental health, and substance use; however, interventions addressing HIV risk behavior are lacking. This study presents pilot findings and lessons learned from a group-based HIV prevention intervention delivered to JDC offenders. Participants were randomized to a five-session HIV prevention (n = 29) or health promotion (n = 28) condition and completed measures of sexual risk taking and substance use at baseline and 3 months postintervention. No between-group differences by time emerged on measures of sexual risk taking or other HIV-related behaviors and attitudes. Both groups improved their rates of HIV testing and decreased their substance use during sex over time. Delivering an HIV prevention intervention to drug court offenders is feasible; however, more intensive interventions that incorporate multiple systems and address co-occurring mental health difficulties may...

This study uses routine activity theory and research on victimization and fear-of-crime to contextualize the importance of examining characteristics related to crime-target vulnerability among public transit commuters. A Principal Component Analysis was conducted using 5-year data from the American Community Survey 2010. New York City (NYC) Police Department Compstat data for 2010 were used to provide a backcloth for understanding the types of crime problems vulnerable transit commuters may confront in their local areas. Findings show that a majority (55.3 per cent ) of the NYC commuters used public transit to travel to work, with more females, youths, ethnic minorities and non-naturalized immigrants commuting by public transit. Two distinct types of transit commuters were found to cluster in different parts of NYC, where the types of local-area crime problems also differed. These findings can help transit operators and policymakers build guardianship and assist place management in areas where potentially vulnerable commuters live.

The Italian Ministry of Justice and that of Health have established two strategies to limit the spread of COVID-19 in prisons: progressive isolation from the external world and adoption of practices to identify possible cases and to treat infected subjects. After the announcement of regulations revolts erupted in numerous Italian prisons. The motivations and effects of these strategy are discussed critically into the search for a balance between the right to health and other rights of prisoners in Italian prisons with the problem of an occupancy level of 121.75%.

Incarcerated individuals in the United States are reportedly four times more likely to be infected with HIV than members of the general population, and a substantial proportion have a history of drug use. Postincarceration, many struggle to maintain their antiretroviral therapy (ART) regimen. This pilot study tested the potential performance of two ART adherence interventions, Project ADHerence Education and Risk Evaluation (ADHERE) and Medication Adherence and Care Engagement (MACE) among drug-using HIV-infected formerly incarcerated individuals in New York City. Thirty participants were randomized and completed the ADHERE or MACE intervention. Participants were interviewed and had their blood drawn for viral load testing at baseline and 3 months postintervention. Our findings suggest that drug-using HIV-infected formerly incarcerated individuals can benefit from brief ART adherence interventions. They also suggest that marijuana use may not have a negative impact on ART adherence.

Prior research has not examined the self-identified goals and plans of incarcerated people as they approach release from prison. This study analyzed the goals and plans generated during a motivational interviewing counseling session of incarcerated men who participated in a randomized controlled trial of a smoking abstinence intervention in a tobacco-free prison in the northeastern United States. Using thematic analysis, 53 written goals and plans were independently coded by trained research assistants to identify major themes that included (1) staying smoke-free or reducing the number of cigarettes smoked postrelease, (2) engaging in physical activities to improve health and wellness, and (3) spending time with family and/or friends. Implications for working with inmates to identify their plans and goals to remain smoke-free after incarceration are discussed.

The Rapid Opioid Dependence Screen (RODS) is an 8-item measure of opioid dependence designed for quick, targeted screening in clinical and research settings. Based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, criteria, the RODS has an average administration of less than 2 minutes and can easily be administered as a stand-alone instrument or as part of a comprehensive interview. This study reports on the initial validation of the RODS among a sample of 97 newly incarcerated, HIV-positive individuals. Using the Mini International Neuropsychiatric Interview as the primary measure of opioid dependence, the RODS showed good-to-strong sensitivity (.97), specificity (.76), positive predictive value (.69), and negative predictive value (.98), while concordance analysis revealed moderate diagnostic agreement (κ = .67). Psychometric properties revealed strong internal consistency (α = .92) and inter-item correlations (.66 to .87).

The growth of the prison system in recent years and its need for continuous operations have required correctional officers to adjust to night and shift work, which creates special demands on their health and performance. Working when he or she would otherwise be asleep, the officer's biological clock can produce physiological, psychological, and behavioral changes that compromise attention, reaction time,

Incarceration history can affect sexual health behaviors. A randomized controlled trial of a prevention intervention tailored for post-incarcerated men was administered in a reentry setting. Men ≤45 days post release were recruited into a five-session intervention study. Participants ( N = 255) were assessed and tested for three sexually transmitted diseases (STDs) and HIV at baseline and 3 months post-intervention and followed up for 3 more months. The intervention group's STD risks knowledge ( p < .001), partner communication about condoms ( p < .001), and condom application skills ( p < .001) improved. Although fewer men tested positive for an STD at 3 months post-intervention (10% vs. 8%) and no new HIV cases were found, the finding was not significant. A tailored risk reduction intervention for men with incarceration histories can affect sexual risk behaviors.

The use of restrictive housing as a correctional management tool has received much attention in recent years, especially as it impacts psychological functioning. While there is considerable literature advocating for the reduced use of restrictive housing, much of it is based on opinions, interview data, and testimonials. This article reviews only the empirical evidence regarding the effects of restrictive housing on psychological functioning in actual correctional settings. Results of this review indicate that only a limited number of empirical studies examine the effects of restrictive housing on mental functioning in correctional settings. Findings from these studies are mixed and are fraught with definitional, geographic, and methodological problems. These problems are identified and discussed. Also, suggestions are made for future research directions to more clearly understand the effects of restrictive housing on psychological functioning.

Despite the extensive resources expended on providing medical care to inmates, inmates' health perception is an understudied topic. The current study investigates inmates' perception of health status while incarcerated using a sample of 136 soon-to-be released prisoners. Prisoners with poor health perception prior to their current incarceration were most likely to perceive health improvement. Sociodemographic characteristics were generally not associated with the perceived health improvement during incarceration. Analysis results suggest correctional institutions may play a vital role in delivering much-needed medical care to a segment of the prisoner population, including determining how they feel about their health. It is important to explore the policies and practices to increase continuity of health care following release to maintain perceived health improvement.

Bellevue Hospital's prison ward cares for male prisoners requiring medical attention that exceeds the capabilities of New York City Department of Correction (NYC-DOC) infirmaries. This study evaluated the injury patterns that occur in this patient population. Data were collected on consecutive prisoners transferred from NYC-DOC for traumatic injuries from June 1, 2003, to June 1, 2006, and analyzed by retrospective chart review. Overall, 251 patients were evaluated for traumatic injuries. Injury mechanisms were violent (75.7%), nonviolent (23.5%), and self-inflicted (0.8%). Of the 241 (96%) patients admitted, 213 (84.9%) required operative intervention. The most common injuries were mandible fractures (46.5%) and facial fractures (14.9%).

Correctional facilities typically house large numbers of persons in close and crowded conditions for long periods. Clusters of communicable diseases ranging from simple viral upper respiratory infections to more serious threats, such as tuberculosis (TB), infections with methicillin-resistant Staphylococcus aureus, and influenza, often emerge in these surroundings. The recent H1N1 influenza pandemic highlights the importance of outbreak prevention and containment preparedness, particularly in congregate settings. In this commentary, the authors propose that the TB control model can provide valuable lessons for infection control practitioners to prepare for, identify, investigate, and control outbreaks of communicable diseases to prevent transmission in correctional facilities and to the surrounding community.