Intellectual and developmental disabilities in Ontario's criminal justice and forensic mental health systems: Using data to tell the story.

BACKGROUND: International studies show that adults with intellectual and developmental disabilities (IDD) are disproportionately represented in the criminal justice and forensic mental health systems; however, it is difficult to capture their involvement across systems in any one jurisdiction. AIMS: The current study aimed to estimate the prevalence of IDD across different parts of the criminal justice and forensic mental health systems in Ontario and to describe the demographic and clinical profiles of these individuals relative to their counterparts without IDD. METHODS: This project utilised administrative data to identify and describe the demographic and clinical characteristics of adults with IDD and criminal justice or forensic involvement across four sectors: federal correctional facilities, provincial correctional facilities, forensic inpatient mental health care and community mental health programmes. Questions were driven by and results were contextualised by a project advisory group and people with lived experience from the different sectors studied, resulting in a series of recommendations. RESULTS: Adults with IDD were over-represented in each of the four settings, ranging from 2.1% in federal corrections to 16.7% in forensic inpatient care. Between 20% (forensic inpatient) and 38.4% (provincial corrections) were under the age of 25 and between 34.5% (forensic inpatient) and 41.8% (provincial corrections) resided in the lowest income neighbourhoods. Medical complexity and rates of co-occurring mental health conditions were higher for people with IDD than those without IDD in federal and provincial corrections. CONCLUSIONS: Establishing a population-based understanding of people with IDD within these sectors is an essential first step towards understanding and addressing service and care needs. Building on the perspectives of people who work in and use these systems, this paper concludes with intervention recommendations before, during and after justice involvement.

Violence-Related Death in Young Australians After Contact With the Youth Justice System: A Data Linkage Study.

Little is known outside of the United States about the risk of violence-related death among young people who have had contact with the youth justice system (justice-involved young people). We examined violence-related deaths among justice-involved young people in Queensland, Australia. In this study, youth justice records for 48,647 young people (10-18 years at baseline) who were charged, or experienced a community-based order or youth detention in Queensland, Australia (1993-2014) were probabilistically linked with death, coroner, and adult correctional records (1993-2016). We calculated violence-related crude mortality rates (CMRs) and age- and sex-standardized mortality ratios (SMRs). We constructed a cause-specific Cox regression model to identify predictors of violence-related deaths. Of 1,328 deaths in the cohort, 57 (4%) were from violence. The violence-related CMR was 9.5 per 100,000 person-years (95% confidence interval [95% CI] [7.4, 12.4]) and the SMR was 6.8 [5.3, 8.9]. Young Indigenous people had a greater risk of violence-related death than non-Indigenous people (cause-specific hazard ratio [csHR] 2.5; [1.5, 4.4]). Young people who experienced detention had more than twice the risk of violence-related death than those who were charged only (csHR 2.5; [1.2, 5.3]). We found that justice-involved young people have a risk of dying from violence that far exceeds that of the general population. The rate of violence-related death found in this study is lower than that in U.S.-based studies, which most likely reflects lower population level firearm violence in Australia. In Australia, young Indigenous people and those released from detention appear key groups to target for violence prevention efforts.

COVID-19 in corrections: Quarantine of incarcerated people.

Carceral settings in the United States have been the source of many single site COVID-19 outbreaks. Quarantine is a strategy used to mitigate the spread of COVID-19 in correctional settings, and specific quarantine practices differ state to state. To better understand how states are using quarantine in prisons, we reviewed each state's definition of quarantine and compared each state's definition to the Centers for Disease Control's (CDC) definition and recommendations for quarantine in jails and prisons. Most prison systems, 45 of 53, define quarantine, but definitions vary widely. No state published definitions of quarantine that align with all CDC recommendations, and only 9 states provide quarantine data. In these states, the highest recorded quarantine rate occurred in Ohio in May 2020 at 843 per 1,000. It is necessary for prison systems to standardize their definitions of quarantine and to utilize quarantine practices in accordance with CDC recommendations. In addition, data transparency is needed to better understand the use of quarantine and its effectiveness at mitigating COVID-19 outbreaks in carceral settings.

Symptomatic menopause: Additional challenges for incarcerated women.

Menopause is an age-associated physiological transition in women, usually occurring between the ages of 40 and 58 years, with an average of 51 years. As the age of women residing in the prison system is increasing globally, it becomes increasingly important for older female inmates to be assessed for menopausal symptoms and offered effective, personalized management. Middle-aged and older women, regardless of their living situation, are at increased risk of experiencing vasomotor symptoms and developing pelvic floor problems, bladder dysfunction and osteoporosis. However, all of these menopausal sequelae are typically exacerbated by prison conditions and by a lack of health support. Therefore, it is critical to implement prison programs and to create gender-specific training to aid in the health care needs of aging female inmates. Addressing this growing population of incarcerated women and attending to their menopausal needs require advocacy and active monitoring of prison-specific templates of care to ensure quality care. One such initiative legislated to address the health care needs of incarcerated women was commenced in New Jersey, USA. This entity, the NJ Commission on Women's Reentry, is addressing the unique health care needs of women, including menopausal ones, while incarcerated and then upon reentry into their community.

Viral hepatitis in correctional facilities in the Northern Territory of Australia 2003-2017.

BACKGROUND: The demographic of Northern Territory prison population differs than elsewhere in Australia and the prevalence of hepatitis B and hepatitis C may therefore be somewhat different from other jurisdictions. There has been no study which has specifically described the serological results of a large proportion of prisoners in Northern Territory correctional facilities over an extended period of time. METHODS: This retrospective longitudinal study reviewed serological results and testing rates for hepatitis B, and hepatitis C performed in correctional facilities in the Northern Territory of Australia between July 1st, 2003 and June 30th, 2017. RESULTS: The proportion of positive records over 14 years for hepatitis B surface antigen (HBsAg) was 641/12,066 (5.3, 95% CI 4.9-5.7), for hepatitis B core antibody (anti-HBc) 4937/12,138 (40.1, 95%CI 39.8-41.6), for hepatitis B surface antibody (anti-HBs) 6966/13,303 (52.4, 95% CI 51.5-53.2), and for hepatitis C antibody 569/12,153 (4.7, 95% CI 4.3-5.1). The proportion of prisoners tested for hepatitis B and hepatitis C has decreased since 2015, while a high proportion of prisoners remain non-immune to hepatitis B. CONCLUSION: There is a relatively high proportion of positive serological markers of hepatitis B, and a lower proportion of positive hepatitis C serology in the Northern Territory's correctional facilities compared to overall Australian rates. As the proportion of prisoners tested for hepatitis B and C has decreased recently, and a high proportion of prisoners remain non-immune to hepatitis B, there are opportunities to increase testing and vaccination rates in this population.

Mass SARS-CoV-2 Testing in a Dormitory-Style Correctional Facility in Arkansas.

Objectives. To assess SARS-CoV-2 transmission within a correctional facility and recommend mitigation strategies.Methods. From April 29 to May 15, 2020, we established the point prevalence of COVID-19 among incarcerated persons and staff within a correctional facility in Arkansas. Participants provided respiratory specimens for SARS-CoV-2 testing and completed questionnaires on symptoms and factors associated with transmission.Results. Of 1647 incarcerated persons and 128 staff tested, 30.5% of incarcerated persons (range by housing unit = 0.0%-58.2%) and 2.3% of staff tested positive for SARS-CoV-2. Among those who tested positive and responded to symptom questions (431 incarcerated persons, 3 staff), 81.2% and 33.3% were asymptomatic, respectively. Most incarcerated persons (58.0%) reported wearing cloth face coverings 8 hours or less per day, and 63.3% reported close contact with someone other than their bunkmate.Conclusions. If testing remained limited to symptomatic individuals, fewer cases would have been detected or detection would have been delayed, allowing transmission to continue. Rapid implementation of mass testing and strict enforcement of infection prevention and control measures may be needed to mitigate spread of SARS-CoV-2 in this setting.

The Cal-DSH diversion guidelines.

The Cal-DSH Diversion Guidelines provide 10 general guidelines that jurisdictions should consider when developing diversion programs for individuals with a serious mental illness (SMI) who become involved in the criminal justice system. Screening for SMI in a jail setting is reviewed. In addition, important treatment interventions for SMI and substance use disorders are highlighted with the need to address criminogenic risk factors highlighted.

Differences in Sexual Health Outcomes Between Adolescents in Public Schools and Juvenile Correctional Facilities.

Data from a statewide, anonymous survey were used to test for differences between adolescents' sexual health behaviors and their outcomes across settings. Youth in juvenile correctional facilities (JCFs) were disproportionally male and Black compared to their peers in public schools. Youth in JCFs were significantly more likely than their peers to report that they had ever had sex, used substances prior to last sex, or been involved in a pregnancy. They were less likely to have used condoms or contraception at last sex, or to report having talked with their partners about sexually transmitted infections or birth control. The results highlight the importance of comprehensive sexual health education and access to a reproductive health provider for students in JCFs.

The Prevalence and Longitudinal Patterns of Continuous Community Violence Exposure and Trauma-Related Symptoms in Adolescent Male Serious Offenders.

The current study examined the longitudinal patterns of continuous exposure to community violence (ECV) and associated symptoms in serious adolescent male offenders. Using data from the Pathways to Desistance Study (Schubert et al., 2004), the current study examined the prevalence of continuous ECV and the stability in exposure over a 3-year period in 1,170 adolescent male offenders (M age at baseline = 16.05 years, SD = 1.15). The results revealed variability in adolescent offenders' ECV and trauma-related symptoms. A latent class analysis identified three classes of participants at each time point: "witnessed with hostility," "dually exposed [i.e., high probability of both witnessing and victimization] with anxiety and hostility," and "no/low exposure with anxiety and hostility." Participants in the witnessed with hostility class reported more baseline ECV than those in the other classes, ds = 0.62-1.37, and more violent offenses than those in the dually exposed with anxiety and hostility class, d = 0.48. In addition, participants in the witnessed with hostility class were older, d = 0.10, and reported more violent offenses at baseline, d = 0.07, than those in the no/low exposure class; however, participants in the no/low exposure class reported spending more time in secure settings with no community access than those in the witnessed with hostility class, d = 0.20. A latent transition analysis over a 3-year period revealed relatively high stability in ECV and trauma-related symptoms over time, with a large proportion of participants remaining in the same violence and trauma class at each transition.

The Consequences of Incarceration for Mortality in the United States.

Previous research has suggested that incarceration has negative implications for individuals' well-being, health, and mortality. Most of these studies, however, have not followed former prisoners over an extended period and into older adult ages, when the risk of health deterioration and mortality is the greatest. Contributing to this literature, this study is the first to employ the Panel Study of Income Dynamics (PSID) to estimate the long-run association between individual incarceration and mortality over nearly 40 years. We also supplement those analyses with data from the National Longitudinal Survey of Youth 1979 (NLSY79). We then use these estimates to investigate the implications of the U.S. incarceration regime and the post-1980 incarceration boom for the U.S. health and mortality disadvantage relative to industrialized peer countries (the United Kingdom).

Estimating the impact of wide scale uptake of screening and medications for opioid use disorder in US prisons and jails.

BACKGROUND: Medications for opioid use disorder (OUD) are the most effective treatment for OUD, but uptake of these life-saving medications has been extremely limited in US prisons and jail settings, and limited data are available to guide policy decisions. The objective of this study was to estimate the impact of screening and treatment with medications for OUD in US prisons and jails on post-release opioid-related mortality. METHODS: We used data from the National Center for Vital Statistics, the Bureau of Justice Statistics, and relevant literature to construct Monte Carlo simulations of a counterfactual scenario in which wide scale uptake of screening and treatment with medications for OUD occurred in US prisons and jails in 2016. RESULTS: Our model predicted that 1840 (95% Simulation Interval [SI]: -2757 - 4959) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated. The model also predicted that approximately 4400 (95% SI: 2675 - 5557) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated and were retained in treatment post-release. These estimates correspond to 668 (95% SI: -1008 - 1812) and 1609 (95% SI: 972 - 2037) lives saved per 10,000 persons incarcerated, respectively. CONCLUSIONS: Prison and jail-based programs that comprehensively screen and provide treatment with medications for OUD have the potential to produce substantial reductions in opioid-related overdose deaths in a high-risk population; however, retention on treatment post-release is a key driver of population level impact.

Jail diversion: a practical primer.

The United States has the highest incarceration rate in the world. With a substantial number of inmates diagnosed with mental illness, substance use, or both, various diversion strategies have been developed to help decrease and avoid criminalization of individuals with mental illness. This article focuses primarily on the first three Sequential Intercept Model intercept points as related to jail diversion and reviews types of diversion programs, research outcomes for diversion programs, and important components that contribute to successful diversion.

Hepatitis C Virus and Hispanic Criminal Justice Clients: A Missed Opportunity.

To compare the willingness for HCV testing, HCV-knowledge, socio economic status, and HCV related risky behavior among male and female Latino offenders. Participants (n = 201) were recruited from the corrections system in Miami and interviewed. Backward stepwise logistic regression was conducted to compare gender-associated risk. Females (n = 81) were more likely to be engaged in risky sexual and drug behavior compared to males (n = 120). Overall, around 70% of the study population were interested to be tested for HCV if offered with no gender difference (OR 1.4, 95% CI 0.4-4.9). However, females were more likely to have lower income (OR 0.6, 95% CI 0.5-0.9) and engage in more HCV related risky sexual behaviors (OR 2.9, 95% CI 1.3-6.2), despite having better HCV related knowledge in five out of six items (OR 1.5-3.2), but had less crime activity (OR 0.6, 95% CI 0.5-0.8). HCV screening among Latino offenders would offer an efficient opportunity to reduce its burden as well as increase knowledge among vulnerable and high-risk population.