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.

Peer Support Programs to Reduce Organizational Stress and Trauma for Public Safety Workers: A Scoping Review.

BACKGROUND: Public safety workers (PSWs), including correctional officers (COs), law enforcement, firefighters, emergency medical service, and military personnel, are at risk of organizational stress and burnout. Exposure to traumatic events, job hazards, injuries, fatalities, and work-related stressors such as work overload, irregular shift assignments, and lack of administrative support can negatively impact PSWs' mental health. Peer support programs (PSPs) have been cited as an intervention to address the mental health of PSWs. PURPOSE: The purpose of this review is to explore the use, including facilitators and barriers, of PSPs to reduce organizational stress and trauma for PSWs. Implications for COs will be discussed. METHOD: A scoping review was conducted using the Arksey and O'Malley methodology. A search was conducted for articles published between 1996 and 2021 using six databases. Selected articles described, implemented, or evaluated peer support as an intervention to reduce PSW organizational stress and trauma. FINDINGS: Thirteen articles met eligibility criteria. Organizational support, including policies, practices, and peer leadership training, contributed to the sustainability of PSPs. Confidentiality, trust, and shared lived experience were also essential to PSP. Stigma was identified as the primary barrier to participation. Public safety workers found PSP helpful in normalizing experiences, increasing hope, and decreasing stigma. Peer support programs also serve to bridge the gap in mental health services use. CONCLUSIONS: Peer support programs are a potential mental health intervention to reduce organizational stress and trauma for COs. Awareness of the facilitators and barriers to PSPs is the first step in developing such programs.

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.

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.

Initial Development of the Activity Card Sort-Advancing Inclusive Participation from a Homeless Population Perspective.

METHODS: Develop a new version of the Activity Card Sort-Advancing Inclusive Participation to include occupations experienced by the homeless population, including nonsanctioned occupations. This study occurred in two phases: (1) tool development (item selection, content expert review, line development drawing, and assessment of content validity) and (2) tool use to determine face validity. Participants were selected through a convenience sample at a local homeless shelter and academic institution. Participants experiencing homelessness (phase 1: N = 13, phase 2: N = 10) were required to be seeking services at the homeless shelter, while nonhomeless participants (phase 2: N = 30) worked full-time, resided with a significant other, and had personal transportation. RESULTS: An assessment of 76 occupations, corresponding line drawings, and follow-up questions was created. An initial construct validity study demonstrated differences between occupational participation of those who are homeless and nonhomeless in the areas of social engagement, nonsanctioned occupations, work and education, and home management. Both groups reported previous, current, or desired engagement in the occupations identified in the assessment. Conclusions and relevance. The purpose of this study was to create an inclusive assessment for use in the homeless population and complete a construct validity study of the assessment tool. Although the results indicated some differences in the frequency with which occupations were performed, the results demonstrated that all individuals participate in occupations that many not contribute to their health and wellness. This initial work supports the future development of a tool that is inclusive of all occupations to obtain a holistic picture of an individual's participation.

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

IMPORTANCE: Jail officers are an underserved population of public safety workers at high risk for developing chronic mental health conditions. OBJECTIVE: In response to national calls for the examination of stressors related to the unique work contexts of correctional facilities, we implemented a pilot study informed by the Total Worker Health® (TWH) strategy at two urban and two rural jails. DESIGN: Participatory teams guided areas of interest for a mixed-data needs assessment, including surveys with 320 jail officers to inform focus groups (N = 40). SETTING: Urban and rural jails in the midwestern United States. PARTICIPANTS: Jail correctional officers and sheriff's deputies employed at participating jails. MEASURES: We measured mental health characteristics using the Patient-Reported Outcomes Measurement Information System Global Mental Health scale, the Center for Epidemiologic Studies Depression scale, and the two-item Posttraumatic Stress Disorder Checklist. Constructs to identify workplace characteristics included emotional support, work-family conflict, dangerousness, health climate, organizational operations, effectiveness of training, quality of supervision, and organizational fairness. RESULTS: On the basis of general population estimates, we found that jail officers were at higher risk for mental health disorders, including depression and posttraumatic stress disorder. Jail officers identified workplace health interventions to address individual-, interpersonal-, institutional-, and community-level needs. CONCLUSION: Implementation of a TWH needs assessment in urban and rural jails to identify evidence-informed, multilevel interventions was found to be feasible. Using this assessment, we identified specific workplace health protection and promotion solutions. WHAT THIS ARTICLE ADDS: Results from this study support the profession's vision to influence policies, environments, and systems through collaborative work. This TWH study has implications for practice and research by addressing mental health needs among jail officers and by providing practical applications to create evidence-informed, tailored interventions to promote workplace health in rural and urban jails.

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.

Posttraumatic Stress Disorder and Job Burnout Among Jail Officers.

OBJECTIVE: The aim of this study was to explore posttraumatic stress disorder (PTSD) symptom prevalence and health characteristics among jail correctional officers, a generally understudied population of public safety workers. METHOD: A Conservation of Resources (COR)-inspired framework explored relationships to PTSD symptoms among jail officers (N = 320) employed in Midwest US jails. RESULTS: More than half (53.4%) of jail officers screened positively for PTSD. Hierarchical regression analysis indicates that burnout was a significant predictor of symptoms of PTSD (B = 0.25, P < 0.001). Self-efficacy (B = -0.42, P < 0.01), emotional labor (B = 0.20, P < 0.01), and an anxiety- or depression-related diagnosis (B = 0.92, P < 0.001) remained significant predictors of PTSD-related symptoms in the final step. CONCLUSIONS: Our findings highlight the potentially high prevalence and impact of PTSD among jail officers, and offer implications for public safety workplace health interventions.