Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience.

BACKGROUND: Autism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual's journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes. METHODS: This consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS. RESULTS: The authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS. CONCLUSION: Greater attention needs to be given to this population as they navigate the CJS.

Prevalence and Correlates of Heavy Alcohol use among People Living with HIV who use Unregulated Drugs in Vancouver, Canada.

Among people living with HIV (PLWH), heavy alcohol use is associated with many negative health consequences. However, the impacts of heavy alcohol use are not well described for PLWH who use drugs. Thus, we investigated the prevalence and correlates of heavy alcohol use among a cohort of people who use drugs (PWUD) living with HIV in Vancouver, Canada. We accessed data from an ongoing community-recruited prospective cohort of PLWH who use drugs with linked comprehensive HIV clinical monitoring data. We used generalized linear mixed-effects modeling to identify factors longitudinally associated with periods of heavy alcohol use between December 2005 and December 2019. Of the 896 participants included, 291 (32.5%) reported at least one period with heavy alcohol use. Periods of recent incarceration (Adjusted Odds Ratio [AOR] = 1.48, 95% Confidence Interval [CI]: 1.01-2.17), encounters with police (AOR = 1.87, 95% CI: 1.37-2.56), and older age (AOR = 1.05, 95% CI: 1.02-1.07) were positively associated with heavy alcohol use. Engagement in drug or alcohol treatment (AOR = 0.54, 95% CI: 0.42-0.70) and male gender (AOR = 0.46; 95% CI: 0.27-0.78) were negatively associated with heavy alcohol use. We observed that heavy alcohol use was clearly linked to involvement with the criminal justice system. These findings, together with the protective effects of substance use treatment, suggest the need to expand access for drug and alcohol treatment programs overall, and in particular through the criminal justice system to reduce alcohol-related harms among PLWH who use drugs.

Forensic psychiatric issues in intellectual disability.

Forensic psychiatrists and neuropsychiatrists are likely to encounter individuals with intellectual disability as they are over-represented in the judicial system. These individuals may have the full range of mental illnesses and comorbid conditions, including physical infirmity, sensory deficits, language impairment, and maladaptive behaviors. They are frequently disadvantaged in the judicial system due to lack of comprehension, lack of accommodations, and stigmatization. Decision making capacity may need to be assessed for health care, sexual autonomy, marriage, financial management, making a will, and need for guardianship. The usual approach to conducting an evaluation needs adaptation to fit the unique characteristics and circumstances of the individual with intellectual disability. The forensic consultant can assist attorneys, defendants, and victims in recommending accommodations and the expert witness can provide education to juries.

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.

Labyrinthine and Neuroscientific Impact of Schizophrenia in the Criminal Justice System.

Schizophrenia, a complex neuropsychiatric condition, manifests with severe neurobiological and psychosocial symptoms, including psychosis, cognitive dysfunction, and social withdrawal. Neuroscience links these symptoms to synaptic malfunctions and neurotransmitter dysregulation, leading to a profound disconnection from reality. The disorder significantly affects cognitive, affective, and behavioral functions, causing considerable neuropsychological distress and functional impairments. The interplay of schizophrenia with the criminal justice system is complex, often exacerbating psychiatric stigma and introducing challenging neuroethical dilemmas. From neuroscientific perspective, schizophrenia symptoms are classified into 'positive' (hyperfunctioning or distortion of normal mental processes) and 'negative' (reduction or loss of mental functions). Each category presents distinct medico-legal challenges. Studies, including those from the Clinical Antipsychotic Trials of Intervention Effectiveness, highlight the importance of identifying neurobiological and psychosocial factors that increase the risk of criminal justice involvement, stressing the necessity of addressing concurrent disorders like substance use disorders. This convergence underscores the need for a delicate balance between therapeutic interventions and legal responsibility, advocating for policy reforms and neuroscience-based research initiatives. Such efforts are crucial for improving the management of schizophrenia within the criminal justice system, focusing on both the medical and societal aspects of the disorder.

"We are struggling to seek justice": a study of the criminal justice system and transgender experiences in Pakistan.

Background: This article aims to explore the complex intersection of transgender people's identities within Pakistan's criminal justice system; a nation in South Asia with a vast population of around 220 million. Aim: This paper aims to explore the myriad challenges faced by transgender individuals when they navigate the realms of justice, encompassing encounters with community people, law enforcement, experiences within the prison system, interactions with prosecution, and engagements with the judicial process in Pakistan. Method: Employing a qualitative research methodology, this study draws on one set of semi structured interviews with ten members of the Khawaja Sara communities, representing transgender individuals, within their residential spaces in Peshawar. Findings: Through the lens of an intersectional framework, the study's findings demonstrate the fragile nature of the criminal justice system in Pakistan as it fails to provide justice to transgender people and to safeguard their lives in Peshawar. Conclusion: The study demonstrates entrenched issues like transphobia, cisgenderism, and cisnormativity in the criminal justice system of Pakistan, contributing to suboptimal case handling and the exacerbation of hate crimes against the Khawaja Sara communities in Peshawar. Consequently, a considerable number of cases involving transgender individuals either go unreported or witness the voluntary withdrawal of First Information Reports (FIRs), perpetuating a cycle of impunity and significantly compromising the pursuit of justice in Peshawar, Pakistan.

Implementing Interventions for Women and Youth with Traumatic Brain Injury at Transition from Custodial Settings: A Call to Action.

Traumatic brain injury (TBI) is a serious public health concern and overrepresented among justice-involved populations. An emerging area of research focuses on the complex, interrelated and unmet health and social needs of justice-involved women and youth with TBI. Evidence of these needs continues to grow, yet the health and justice systems continue to underperform in supporting the health and social care of justice-involved women and youth. This commentary is a call to action to begin to redress these gaps. We first provide an overview of the needs of women and youth with TBI that affect their transition from custody to community, including those related to victimization, trauma, mental health, substance use, and homelessness. We then highlight the current gaps in knowledge and practice with respect to interventions for women and youth with TBI at transition from custody. The available evidence for the impact of interventions on people with head injury who are justice-involved is sparse, especially studies of interventions focused on women and youth. We conclude with a call for implementation science studies to support translation from research to practice, emphasizing that researchers, practitioners, policy makers, and women and youth at transition should collaborate to develop, implement, and evaluate accommodations and interventions for TBI. To have meaningful, positive impacts on the systems that serve these women and youth, interdisciplinary service delivery approaches should aim to prevent, raise awareness, identify, and provide timely support and services for the varied needs of women and youth with TBI in transition.

Silenced Survivors: A Systematic Review of the Barriers to Reporting, Investigating, Prosecuting, and Sentencing of Adult Female Rape and Sexual Assault.

Sexual victimization of adult women remains an underreported crime. This systematic review identified and synthesized the barriers to reporting, investigating, prosecuting, and sentencing cases of sexual assault and rape against adult women in Western countries. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was conducted on August 3, 2023, across databases including PsycINFO, MEDLINE, Cochrane Library, Scopus, ProQuest Central, Web of Science, MedNar, and ProQuest Dissertations & Theses. Studies meeting the inclusion criteria provided relevant information on the decision not to formally disclose, investigate, prosecute, or convict incidents of sexual assault and rape of adult women. We included 28 studies and identified 70 barriers in total. Identified barriers were most prevalent to reporting, followed by investigating, prosecuting, and, lastly, sentencing. Key themes in the barriers included lack of trust in the criminal justice system, internal reactions, rape myths and societal norms, and perpetrator characteristics. The identified barriers emphasize an urgent need for reform of the criminal justice system's response to sexual assault and rape. Prioritizing victim-survivors' needs, enhancing transparency of the criminal justice system, and addressing attrition rates are crucial. Future studies need to engage with diverse population to address all victim-survivors' needs and provide further insights into the challenges across all stages of the criminal justice system to enhance the outcome of rape and sexual assault cases.

Co-production in the Lost Mothers Project: transforming criminal justice narratives through Lived experience engagement.

The Lost Mothers Project researches the repercussions of mandatory separation between newborns and women in the Criminal Justice System (CJS), aiming to address gaps in evidence and decision-making for pregnant women within the CJS. Co-production with Birth Companions and their Lived Experience Team (LET) is integral, involving substantial input from the LET in various aspects. This paper, written collaboratively, explores the success stories, challenges, and impact of co-production on The Lost Mothers Project, emphasising the profound role of the LET in reshaping the criminal justice landscape for mothers within the system.The LET, comprised of mothers with direct CJS experience, assumes a central role as co-creators and decision-makers, providing invaluable insights into systemic issues. The co-design process, exemplified by refining the project's title and logo, showcases collaborative efforts to reduce isolation and emphasise the transformative power of co-production. Challenges in co-production, such as power dynamics and language barriers, are acknowledged, with strategies for overcoming them discussed. The project's commitment to non-hierarchical co-production ensures equal partnership among all stakeholders. Remuneration for the LET is prioritised, avoiding tokenistic engagement.The co-production paradigm in The Lost Mothers Project contributes to a more compassionate, equitable, and effective criminal justice system. This article concludes that co-production is not just a slogan but a cornerstone for empowering sometimes disempowered populations and fostering positive change in the criminal justice landscape. The transformative impact of the LET in actively shaping the research, coupled with their role as decision-makers, highlights the significance of lived experience engagement in reshaping narratives and creating inclusive research practices within criminal justice studies.

The Lost Mothers Project looks into how separating newborns from mothers in the Criminal Justice System affects women and staff. The research is trying to fill in the missing information and improve how decisions are made. This research, in partnership with Birth Companions and their Lived Experience Team (LET), focuses on getting direct input from mothers who have been in the justice system.The LET, made up of mothers with their own experiences of the system, is crucial in shaping the research. They actively contribute to decisions, like refining the project's title and logo. This involvement aims to make sure the research is not just about them but includes their perspectives, reducing feelings of isolation.Challenges in this collaborative process, such as power dynamics and language barriers, are recognised and strategies to overcome them are discussed. The project commits to a fair and equal partnership among everyone involved, and the LET is compensated for their time.The co-production approach in The Lost Mothers Project is seen as a way to create more understanding, and equality when undertaking research. The article stresses that co-production is not just a trendy idea but a crucial part of making positive changes in how we understand and address issues in the criminal justice system. The LET's active role, both in shaping the research and making decisions, shows the real impact of always including the viewpoints of people who have personally been through the prison system.This collaboratively written article is interwoven with quotations from members of the LET, utilising pseudonyms in certain instances. The paper was initially discussed with the team at one of our regular meetings, where volunteers were invited to contribute; consent was always sought for quotes and contributions. Iterations of the paper have been exchanged back and forth, ensuring accuracy, and relevant papers used as references were collectively read, reviewed and agreed upon.

Developing a coordinated response to chemsex across health, justice and social care settings: expert consensus statement.

SUMMARY: Chemsex occurs primarily among gay, bisexual and other men who have sex with men (GBMSM), and there is evidence of a subgroup of users who carry out chemsex-related criminal offences and experience harm. Challenges with chemsex can present to various settings; there are concerns that harm is increasing, including at interfaces between health, social care and criminal justice systems. The UK response to date has lacked a coordinated approach. An expert reference group was convened to share chemsex knowledge, articulate priorities for research and pathway development, and foster collaborative working between agencies. It made three key recommendations: develop and increase training and awareness across all services; implement a coordinated research programme with the development of a common data-set and assessment tool to fully characterise population-level needs; develop a professional network to share information, provide professional support and act as a knowledge hub. There was support for a unified multi-agency strategy incorporating the priorities identified as overarching principles.

Insufficient criminal justice system response to the severity of domestic violence during the pandemic in Indonesia.

Domestic violence increased dramatically in Indonesia during the COVID-19 pandemic compared to the previous pandemic. This article analyses how Indonesia's criminal justice system responded to domestic violence during the pandemic. This article used secondary data gathered from various online resources and legal publications. This article demonstrated that during the pandemic, victims of domestic violence in Indonesia were unable to access justice due to two significant barriers. Before filing a formal complaint with the appropriate official, victims would prefer to discuss the matter with their relatives. Furthermore, the victims could not report their cases to the responsible official due to mobility constraints. This case demonstrates that in patriarchal societies, the criminal justice system could not handle domestic violence cases more effectively. As a result, the technical operation of the criminal justice system necessitates the development of a novel method of case filing. This article proposes that the Indonesian criminal justice system establish a complaint system based on social media to provide victims of domestic violence with prompt justice. Furthermore, the legal advocacy role of the community in assisting domestic violence victims is critical.

The effectiveness of interventions for offending behaviours in adults with autism spectrum disorders (ASD): a systematic PRISMA review.

Previous research has suggested that the core features of autism spectrum disorders (ASD) may contribute to offending behaviours and increased vulnerability within the Criminal Justice System. To date, there is a paucity of evidence assessing the effectiveness of interventions for offending behaviour in adults with ASD but without co-occurring intellectual disability (ID) across a broad range of forensic settings. The lack of robust evidence is concerning, as limited effectiveness may contribute to an increased likelihood of prolonged incarceration, particularly in the most restrictive settings. A PRISMA systematic review was conducted with a narrative synthesis to: (a) evaluate the evidence of the effectiveness of interventions aimed at reducing recidivism, (b) assess whether the core features of ASD impact the effectiveness of these interventions, and (c) identify additional factors that may affect the effectiveness of interventions within this population. Seven studies involving ten male participants were identified. The findings suggest that interventions for offending behaviours in adults with ASD without intellectual disability (ID) are largely inadequate, and that core ASD features need to be considered. Additionally, a complex interplay of risk factors potentially impacting intervention effectiveness was suggested. Limitations include heterogeneity across intervention types, measures of effectiveness, and what constitutes effectiveness. Despite the limited number of studies and data quality, the review aligns with a growing body of literature highlighting vulnerability and a need for evidence-based interventions for people with ASD. The review also discusses the broader implications of ineffective interventions.

A UK-wide survey of community forensic services for adults with intellectual disability and/or autism.

BACKGROUND: Specialist forensic community teams for people with intellectual disability and/or autism have been developed, but little is known about their extent and delivery. AIMS: To describe specialist forensic community teams for people with intellectual disability and/or autism across the UK. METHOD: An online survey was sent to representatives of each UK Trust/Health Board providing adult mental health and/or intellectual disability services. Questions covered the availability, structure and activities of specialist community forensic services. Quantitative data were summarised and associations between access to specialist forensic teams and care were tested with Chi-squared tests. Thematic analysis of free-text survey responses was used to understand the challenges of providing community forensic mental health services for this group. RESULTS: A total of 49 out of 78 (63%) eligible Trusts/Health Boards responded, of which 25 (51%) had access to a specialist forensic community team. Teams operated either as part of a single Trust/Board (n = 13) or over a larger regional footprint (n = 12). The availability of specialist forensic community teams was associated with better access to offence-related interventions (χ2 = 15.1002, P < 0.005) and co-production of patient care plans (χ2 = 7.8726, P = 0.005). Respondents reported a wide variation in availability, expertise and perceived quality of community services. The availability of secure and generic in-patient beds, commissioning and legal barriers were also significant challenges in providing appropriate care. CONCLUSIONS: Coverage of specialist community forensic teams is not universal. There are indications that such teams are associated with improved care processes, but further work is needed to establish longer-term outcomes and the optimal model of care.

Lost diagnoses? A multi-year trajectory of patients with childhood ADHD in the criminal justice system in Switzerland.

Background: Attention-deficit/hyperactivity disorder (ADHD) is prevalent amongst offenders, increasing risks for aggressive and delinquent behaviors. Since ADHD and its symptoms can persist into adulthood, accurately diagnosing and maintaining diagnoses in offenders is crucial to ensure appropriate treatment and reduce recidivism. Methods: This study employed a retrospective longitudinal design to investigate ADHD amongst adult offenders with a confirmed diagnosis of ADHD during childhood or adolescence at a Swiss forensic outpatient clinic between 2008 and 2021. N = 181 patient files were reviewed, including forensic expert witness assessments and treatment reports. We charted the adulthood trajectory of patients with a confirmed childhood/adolescence ADHD diagnosis, examining the course of their diagnoses. Results: Of 181 patients, evidence indicated that 12 (7%) had an ADHD diagnosis in childhood/adolescence. In 1 (8%) of these 12 cases, the diagnosis was maintained throughout the observation period. For 4 patients (33%), a diagnosis was given in the first forensic psychiatric expert witness assessment in adulthood but subsequently dropped. In another 4 cases (33%), the diagnosis was dropped in adulthood but later re-assigned, whereas in 3 cases (25%), the diagnosis was discontinued throughout the observation period. In 50% of cases with a diagnostic change, the discontinuation of an adult ADHD diagnosis coincided with a newly diagnosed personality disorder (or vice versa). Conclusions: Our findings highlighted considerable inconsistencies in the assignment of adult ADHD diagnoses amongst offenders. Whilst ADHD remission in adulthood occurs, the diagnostic variability in our results warrants detailed scrutiny. One possibility is that ADHD has similar fluctuations to conditions like depression, as argued elsewhere. Equally, diagnoses may become "lost", meaning they are not given even when applicable and replaced by other diagnoses. Additionally, residual symptoms may remain but beyond the diagnostic threshold. This is significant because untreated ADHD can increase re-offending risks and adverse health outcomes.

Substance use treatment completion and criminal justice system contact in Chile: A retrospective, linked data cohort study.

BACKGROUND AND AIMS: Substance use treatment (SUT) has shown to be effective in reducing self-reported offending; however, the association between SUT completion and criminal justice system (CJS) contact has been underexplored, especially in Latin America. This study aimed to estimate the association between SUT completion status and (1) any subsequent CJS contact and (2) CJS contact leading to imprisonment, at 1, 3 and 5 years post-discharge, in Chile. DESIGN: Retrospective cohort study using multivariable survival analysis based on linked administrative data from 2010 to 2019. SETTING: This study took place in Chile, where SUT is available at no cost through Chile's publicly funded health-care, and is provided in outpatient and inpatient modalities in public and private centres. PARTICIPANTS: A total of 70 854 individuals received their first SUT from 2010 to 2019. They were mainly males (76.3%), and their main substance used at admission was cocaine paste (39.2%). MEASUREMENTS: SUT completion status included completion, late dropout (≥ 3 months) and early dropout (< 3 months). Outcomes were (1) any CJS contact and (2) CJS contact leading to imprisonment after baseline treatment. We estimated the association between treatment completion and CJS contact through flexible parametric Royston-Parmar models while adjusting for several covariates. FINDINGS: Those who completed SUT (27.2%) were less likely to have any CJS contact at 5 years post-SUT compared with those who dropped out late [with a gap of -9.5%, 95% confidence interval (CI) = -8.7, -10.3] and early (-11.2%, 95% CI = -10.1, -12.3). Also, those who completed SUT were less likely to have CJS contact leading to imprisonment at 5 years post-SUT compared with those who dropped out late (-2.6%, 95% CI = -2.2, -3.1) and early (-4.0%, 95% CI = -3.3, -4.6). These differences were also observed at 1 and 3 years post-SUT for each outcome. CONCLUSIONS: In Chile, completion of substance use treatment appears to be associated with lower probabilities of both any criminal justice system contact and contact leading to imprisonment.

Stigma Arising from Youth Police Contact: The Protective Role of Mother-Youth Closeness.

Objective: The purpose of this article is to examine the relationship between mother-youth closeness and stigma stemming from police contact. Background: Research increasingly indicates that stigma stemming from police-youth encounters links police contact to compromised outcomes among youth, though less is known about the correlates of stigma stemming from this criminal legal contact. Close mother-youth relationships, commonly understood to be protective for youth outcomes, may be one factor that buffers against stop-related stigma, especially the anticipation of stigma. Method: We use data from the Fragile Families and Child Wellbeing Study, a sample of youth born in urban areas around the turn of the 21st century, to examine the relationship between mother-youth closeness and stop-related stigma. Results: We find that mother-youth closeness is negatively associated with stop-related anticipated stigma but not stop-related experienced stigma. We also find that the relationship between mother-youth closeness and stop-related anticipated stigma is concentrated among youth experiencing a non-intrusive stop. Conclusion: Close mother-youth relationships may protect against stigma stemming from criminal legal contact.

Serious mental illness in probation: A review.

Research into serious mental illness and probation is reviewed. In addition, there is a specific review of the role of specialist mental health probation staff in the United States (US). In the discussion, we compare progress with the care of the seriously mentally ill within probation in Europe and the US. We conclude that the specialist role for probation staff developed in the US has significant advantages which have been well evaluated which should be implemented, in a large multi-centre trial, across Europe.

Probation and COVID-19: Lessons learned to improve health-related practice.

Probation staff perform a health-related role involving identifying health-related drivers of offending behaviour; facilitating access to support for these, including continuity of care for people leaving prison; and advising the courts on appropriate sentencing. This study analyses data from probation staff surveys and interviews with people that were under probation supervision during the pandemic to investigate the impact of the response to the pandemic on a) this health-related role, b) the lived experience of accessing health support whilst engaging with probation, and c) partnership working and pathways into healthcare for people under probation supervision.

Human rights and the invisible nature of incarcerated women in post-apartheid South Africa: prison system progress in adopting the Bangkok Rules.

PURPOSE: The global spotlight is increasingly shone on the situation of women in the male-dominated prison environment. Africa has observed a 24% increase in its female prison population in the past decade. This year is the 10-year anniversary of the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the Bangkok Rules) adopted by the General Assembly on 21 December 2010. DESIGN/METHODOLOGY/APPROACH: Using a legal realist approach, this paper examines South Africa's progress in adopting the Bangkok Rules. This paper documents the historical evolution of the penal system since colonial times, focused on the development of recognition, protection and promotion of human rights of prisoners and an assessment of incarcerated women's situation over time. FINDINGS: The analysis of the human rights treaties, the non-binding international and regional human rights instruments, African court and domestic jurisprudence and extant academic and policy-based literature is cognizant of the evolutionary nature of racial socio-political dimensions in South Africa, and the indeterminate nature of application of historical/existing domestic laws, policies and standards of care when evaluated against the rule of law. ORIGINALITY/VALUE: To date, there has been no legal realist assessment of the situation of women in South Africa's prisons. This paper incorporates race and gendered intersectionality and move beyond hetero-normative ideologies of incarcerated women and the prohibition of discrimination in South African rights assurance. The authors acknowledge State policy-making processes, and they argue for substantive equality of all women deprived of their liberty in South Africa.

Recovery support specialists inside the jail: a program description of treatment engagement for opioid use disorder.

PURPOSE: People living with opioid use disorder (OUD) disproportionately encounter the criminal justice system. Although incarcerated individuals with OUD face higher risk for withdrawals, relapses and overdoses, most jails fail to offer comprehensive medications for OUD (MOUD), including recovery support services and transition of care to a community provider. The purpose of this paper is to describe the development and implementation of a comprehensive MOUD program at a large county jail system in Maricopa County, Arizona. DESIGN/METHODOLOGY/APPROACH: The authors used the Sequential Intercept Model (SIM) to develop a community-based, multi-organizational program for incarcerated individuals with OUD. The SIM is a mapping process of the criminal justice system and was applied in Maricopa County, Arizona to identify gaps in services and strengthen resources at each key intercept. The program applies an integrated care framework that is person-centered and incorporates medical, behavioral and social services to improve population health. FINDINGS: Stakeholders worked collaboratively to develop a multi-point program for incarcerated individuals with OUD that includes an integrated care service with brief screening, MOUD and treatment; a residential treatment program; peer support; community provider referrals; and a court diversion program. Recovery support specialists provide education, support and care coordination between correctional and community health services. ORIGINALITY/VALUE: OUD is a common problem in many correctional health centers. However, many jails do not provide a comprehensive approach to connect incarcerated individuals with OUD treatment. The Maricopa County, Arizona jail system opioid treatment program is unique because of the ongoing support from recovery support specialists during and after incarceration.