Sex Differences in the Effects of Adverse Childhood Experiences on Institutional Misconduct among Adults in Prison.

Research from the past few decades has highlighted the long- and wide-reaching effects of adverse childhood experiences (ACEs). These experiences can negatively affect mental and physical health, as well as behaviors and interpersonal relationships well into adulthood. While it is generally understood that ACEs are prevalent in correctional populations, no prior studies have measured this issue using a large representative and racially and ethnically diverse sample of both male and female adult correctional populations in the United States. The data used for this study were collected via an assessment administered to more than 2,100 adults in Minnesota's prison system. Descriptive findings revealed that multiple and varied forms of ACEs were common in the histories of this state's incarcerated population, particularly among females and incarcerated persons who identified as Black, White/non-Hispanic, and American Indian/Alaskan Native. The multivariate results revealed that past exposure to ACEs increased the likelihood and speed of disciplinary convictions after admission to prison for males, but not for females. Overall, the results underscored the importance of assessing for responsivity factors upon admission to prison, including ACEs.

Factors Differentiating Nursing Homes With Strong Resident Safety Climate: A Qualitative Study of Leadership and Staff Perspectives.

The current qualitative study assessed leadership and staff perceptions related to resident safety at Department of Veterans Affairs (VA) nursing homes with a range of safety climates. We recruited a purposive sample of six VA nursing homes from geographically diverse regions of the United States and with diverse overall safety climate ratings. We conducted semi-structured phone interviews with 43 senior and middle level nursing home leaders and frontline providers (medical and nursing). We performed a thematic analysis of interview data to assess participant perceptions of factors that influence resident safety at higher and lower safety climate sites. Analyses identified two factors that differentiated VA nursing homes with high safety climate ratings from those with medium or low ratings: (1) communication about resident safety, particularly the important role of accessibility of physicians and managers; and (2) leadership support for and responsiveness to resident safety issues raised by frontline staff. Findings from high safety climate nursing homes underscore the importance of leadership accessibility, communication, support, and follow through regarding resident safety concerns. These results may provide a basis for designing safety climate interventions, such as those designed to improve communication, teamwork, and quality improvement structures and processes. [Journal of Gerontological Nursing, 49(2), 13-17.].

Organizational readiness to change as a leverage point for improving safety: a national nursing home survey.

BACKGROUND: A stronger safety climate in nursing homes may reduce avoidable adverse events. Yet efforts to strengthen safety climate may fail if nursing homes are not ready to change. To inform improvement efforts, we examined the link between organizational readiness to change and safety climate. METHODS: Seven safety climate domains and organizational readiness to change were measured with validated Community Living Center/CLC Employee Survey of Attitudes about Resident Safety and Organizational Readiness to Change Assessment. Safety climate domains comprised of safety priorities, supervisor commitment to safety, senior management commitment to safety, safety attitudes, environmental safety, coworker interactions around safety, and global rating of CLC. We specified models with and without readiness to change to explain CLC- and person-level variance in safety climate domains. RESULTS: One thousand three hundred ninety seven workers (frontline staff and managers) responded from 56 US Veterans Health Administration CLCs located throughout the US. Adding readiness to change reduced baseline CLC-level variance of outcomes (2.3-9.3%) by > 70% for interpersonal domains (co-workers, supervisors, and senior management). Readiness to change explained person-level variance of every safety climate domain (P < 0.05), especially for interpersonal domains. CONCLUSIONS: Organizational readiness to change predicted safety climate. Safety climate initiatives that address readiness to change among frontline staff and managers may be more likely to succeed and eventually increase resident safety.

Virtual external implementation facilitation: successful methods for remotely engaging groups in quality improvement.

BACKGROUND: Relatively little guidance exists on how to use virtual implementation facilitation to successfully implement evidence-based practices and innovations into clinical programs. Yet virtual methods are increasingly common. They have potentially wider reach, emergent public health situations necessitate their use, and restrictions on resources can make them more attractive. We therefore outline a set of principles for virtual external implementation facilitation and a series of recommendations based on extensive experience successfully using virtual external implementation facilitation in a national program. MODEL AND RECOMMENDATIONS: Success in virtual external implementation facilitation may be achieved by facilitators applying three overarching principles: pilot everything, incorporate a model, and prioritize metacognition. Five practical principles also help: plan in advance, communicate in real time, build relationships, engage participants, and construct a virtual room for participants. We present eight concrete suggestions for enacting the practical principles: (1) assign key facilitation roles to facilitation team members to ensure the program runs smoothly; (2) create small cohorts of participants so they can have meaningful interactions; (3) provide clarity and structure for all participant interactions; (4) structure program content to ensure key points are described, reinforced, and practiced; (5) use visuals to supplement audio content; (6) build activities into the agenda that enable participants to immediately apply knowledge at their own sites, separate from the virtual experience; (7) create backup plans whenever possible; and (8) engage all participants in the program. These principles represent a novel conceptualization of virtual external implementation facilitation, giving structure to a process that has been, to date, inadequately described. The associated actions are demonstrably useful in supporting the principles and offer teams interested in virtual external implementation facilitation concrete methods by which to ensure success. Our examples stem from experiences in healthcare. But the principles can, in theory, be applied to virtual external implementation facilitation regardless of setting, as they and the associated actions are not setting specific.

Safety Climate Associated With Adverse Events in Nursing Homes: A National VA Study.

OBJECTIVES: Adverse events in nursing homes are leading causes of morbidity and mortality, prompting facilities to investigate their antecedents. This study examined the contribution of safety climate-how frontline staff typically think about safety and act on safety issues-to adverse events in Veterans Affairs (VA) nursing homes or Community Living Centers (CLCs). DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A total of 56 CLCs nationwide, 1397 and 1645 CLC staff (including nurses, nursing assistants, and clinicians/specialists), respectively, responded to the CLC Employee Survey of Attitudes about Resident Safety (CESARS) in 2017 and 2018. METHODS: Adverse events (pressure ulcers, falls, major injuries from falls, and catheter use) were measured using the FY2017-FY2018 Minimum Data Set (MDS). Safety climate was defined as 7 CESARS domains (safety priorities, supervisor commitment to safety, senior management commitment to safety, personal attitudes toward safety, environmental safety, coworker interactions around safety, and global rating of CLC). The associations between safety climate domains and each adverse event were determined separately for each frontline group, using beta-logistic regression with random effects. RESULTS: Better ratings of supervisor commitment to safety were associated with lower rates of major injuries from falls [odds ratio (OR) 0.33, 95% confidence interval (CI) 0.11-0.97, clinicians] and catheter use (OR 0.42, 95% CI 0.21-0.85, nurses), and better ratings of environmental safety were associated with lower rates of pressure ulcers (OR 0.23, 95% CI 0.09-0.61, clinicians), major injuries from falls (OR 0.48, 95% CI 0.24-0.93, nurses), and catheter use (OR 0.55, 95% CI 0.32-0.93, nursing assistants). Better global CLC ratings were associated with higher rates of catheter use. No other safety climate domains had significant associations. CONCLUSIONS AND IMPLICATIONS: Nursing homes may reduce adverse events by fostering supportive supervision of frontline staff and a safer physical environment.

Relationship Between Work Experience and Safety Climate in Veterans Affairs Nursing Homes Nationwide.

OBJECTIVES: Staff values and beliefs about resident safety (safety climate) represent one potential driver of nursing home safety. Staff with more work experience (length of service) may possess richer knowledge of resident safety for strengthening safety climate. We investigated the association of length of service with safety climate in the U.S. Department of Veterans Affairs nursing homes or Community Living Centers (CLCs). METHODS: Fifty-six of 134 CLCs participated in 2017 and then 2018 in the previously validated CLC Employee Survey of Attitudes about Resident Safety, which comprised 7 safety climate domains and employee characteristics. We conducted 2 cross-sectional analyses of length of service on each safety climate domain, controlling for occupation, shift, work hours, and clustering by VA hospital, service network, and geographic region, in mixed random-effect regression models. RESULTS: A total of 1397 and 1645 staff participated in the survey (26% and 28% response rates) at round 1 and 2, respectively. At each round participants working greater than 6 months were less positive than those working less than 6 months about supervisor commitment to safety, coworker interactions around safety, and CLC global ratings. CONCLUSIONS: Differences in work experience contributed to incongruence in perceptions about supervisors, coworkers, and the facility. Workers with more experience may have higher perceived job aptitude and thus higher expectations of supervisory recognition and more criticisms of coworkers. Pairing experienced workers with newer ones may narrow the knowledge gap and increase collaboration. Huddles, team meetings, and organizational initiatives represent opportunities to recognize and leverage experienced workers' accumulated safety knowledge.

An outcome evaluation of a prison-based life-skills program: the power of people.

The Power of People (PoP) is a personal leadership development course that was originally developed in a non-correctional setting and now serves as a prison-based life skills course. This study examined PoP's effect on four different types of recidivism: rearrest, reconviction, reincarceration, and technical violation revocation. The results of the analyses revealed that PoP does not have a significant effect on any of the four measures of recidivism. Following established principles of effective correctional treatment, we make several recommendations that could improve PoP's effectiveness on recidivism outcomes. Overall, this study provides guidance on how to make programs not originally designed for correctional systems into effective recidivism-reducing tools.

Why are crime victims at risk of being victimized again? Substance use, depression, and offending as mediators of the victimization-revictimization link.

Using three waves of data from 5,165 male and 5,924 female teenagers surveyed in the National Longitudinal Study of Adolescent Health, this study tested whether drug use, alcohol use, depression, and offending mediate the link between a serious violent criminal victimization and a subsequent serious violent revictimization. Results indicated that victimization at Wave 1 significantly predicted changes in violent offending, delinquency, and drug use at Wave 2, even controlling for all other lagged mediators. Violent offending emerged as a robust and consistent mediator of the victimization-revictimization link for males. For females, all the mediators together produced a significant and large indirect effect that reduced the direct effect of prior victimization to nonsignificance, but no one single mediator was significant. This study demonstrates that revictimization is partially the result of behavioral changes following victimization. The fact that mediation between victimization and revictimization occurred through a cluster of changed behaviors and moods suggests that the impact of victimization is greater for females than males. This evidence that victimization changes behavior and increases risks and that these risks differ by gender has implications for both mental health care and law enforcement.

Easy access to firearms: juveniles' risks for violent offending and violent victimization.

Keeping firearms at home may increase personal safety but it may also increase the risk of injury. This study uses data from three waves of the National Longitudinal Study of Adolescent Health to assess the extent to which adolescents' easy access to firearms at home increases the risk of violent offending and violent victimization. Access to firearms was higher for males, Whites, and adolescents having two parents, especially fathers. Current access to firearms at home significantly increased the odds of both violent offending and violent victimization, even after controlling for prior access, prior offending, and prior victimization. This relationship persisted into early adulthood; access to firearms still significantly increased the odds of violent offending and violent victimization.