Revisiting the effectiveness of cognitive-behavioural therapy for reducing reoffending in the criminal justice system: A systematic review.

This is the protocol for a Campbell systematic review. The objectives are as follows. The proposed systematic review is an update to, and extension of, Lipsey et al. (2007). As such we build on their previous aims to: (i) Assess and synthesise the overall impact of cognitive behavioural therapy (CBT) on offender recidivism; (ii) Examine possible sources of variability in the effectiveness of CBT. Data permitting, we will examine if the effectiveness of CBT varies by: (a) Characteristics of the CBT intervention (e.g., cognitive restructuring vs. cognitive skills training, group v. individual implementation; and/or custodial v. community setting, and/or), (b) Characteristics of the population (e.g., juveniles vs. adult offenders), (c) Implementation factors (e.g., implementing practitioner, use of structured/manualised approaches, delivery mode, and/or programme duration or intensity), (d) Evaluation methods (e.g., randomised vs. non-randomised research designs); (iv) Determine whether there is a decline in the effect of CBT on recidivism over time; and (v) Investigate whether there is an interaction between implementation factors and time in terms of the effect on recidivism.

Does Being Over 60 Years Old at Index Offense Impact Sexual Recidivism Risk? A Large-Scale Comparison of Men Released Over the Age of 60.

Research has consistently found risk for sexual recidivism drops as men convicted of a sexual offense age. One question that remains, however, is whether this age-related reduction in risk applies to men who commit their sexual offenses at an older age. The current study examined this question in a sample of 939 men who were screened for civil management and released to the community (mean follow-up = 6.33 years, SD = 3.98 years), by comparing the sexual recidivism rates of (a) 238 men convicted of sexual offenses committed over the age of 60 (Over-60 Index group), and (b) 701 men who committed sexual offenses under the age of 60 but who were released to the community over the age of 60 (Under-60 Index group). Even though the Under-60 Index group was significantly higher risk at release, the Over-60 Index group sexually recidivated at a significantly higher rate, a difference largely driven by the small group of men who had committed sexual offenses both under and over the age of 60. The Static-99R was a strong predictor of sexual recidivism regardless of age at sexual offending (i.e., just under 60, just over 60, or both under and over 60). The 2021 Routine Samples norms significantly overpredicted sexual recidivism for the Under-60 Index group and significantly underpredicted sexual recidivism for the Over-60 Index group, indicating that the use of the 2016 High Risk/High Needs norms could be more appropriate for the Over-60 Index group, particularly those men who sexually offended under the age of 60 before sexually offending over the age of 60.

Surreptitious Area of Middle Ear - the Sinus Tympani.

Sinus tympani is one of the hidden space in the retrotympanic area of middle ear which is commonly invaded by cholesteatoma and known for recidivism. Conventional surgical approaches sometimes fail to access deep sinuses and eradicate the disease. The aim of our study was to measure endoscopic depth of Sinus tympani in Indian Population. Total of 30 patients underwent mastoid exploration and intraoperatively depth of Sinus Tympani was measured using a 0.5 mm calibrated probe with 30 degree rigid Hopkins endoscope. Endoscopic depth in the present study ranges between 2.5 and 5.5 mm. It was higher in right ear in case of females however no significant difference were seen in males and females on left side. It is difficult to clear disease from Sinus Tympani because of its inaccessible location. Sinus Tympani can also show variations in terms of its depth further making difficult to clear disease.

Characteristics of Patients Presenting at an Emergency Department for a Heroin Overdose vs Detoxification.

Purpose: This study compares substance use, treatment histories, and sociodemographic characteristics of patients presenting to an emergency department (ED) following a heroin overdose or seeking detoxification services for heroin and examines risk factors for a subsequent return to the ED for a substance-related problem. Methods: A convenience sample of patients presenting for an overdose or detoxification at an urban teaching ED was recruited for this study. During their ED visit, patients were interviewed regarding demographics, substance use experiences, and treatment history. Subsequently, a review of patient records for past and subsequent ED use was performed. Results: Patients requesting detox and those with an overdose were similar in terms of prior treatment. Both groups had similar extensive polysubstance histories. As a group, however, patients presenting for detox were more likely to report use of each of three substances (benzodiazepines, opioid pain medications, and heroin) more than three times per week, compared to those presenting for overdose. Detox patients had higher scores on the 3-item Alcohol Use Disorder Identification Test-C and the drug problems scale compared to overdose patients. Overall, 28% of the patients returned to the ED within 90 days for a drug-related issue, including 8% that returned for an overdose. Factors predictive of a return ED visit included ED visits for substance use in the previous year and recent frequent heroin use. Conclusion: Patients requesting detox were similar in most domains to those presenting following an overdose. Notably, overdose patients were less likely to use heroin more than three times per week compared to detox patients. Both groups were equally likely to return for an SUD reason within 3-months, however for both groups, previous ED visits and recent frequent heroin use predicted a return visit.

Case report: Assessing criminal responsibility and recidivism risk in the behavioral variant of frontotemporal dementia.

Frontotemporal dementia (FTD) affects the frontal and temporal lobes of the brain, leading to personality changes, language impairments, and behavioral disturbances, including impulsivity and disinhibition. Assessing responsibility and recidivism risk in forensic evaluations is challenging due to the evolving nature of FTD. Despite limited literature, we present a case of a 45-year-old man with no prior legal or medical history, who committed criminal acts due to behavioral changes linked to the behavioral variant of frontotemporal dementia (bvFTD). Initial assessment found him irresponsible, with a non-evaluable risk of recidivism. Subsequent evaluation showed a low recidivism risk based on clinical evolution. We discuss these findings considering existing literature and Swiss jurisprudence.

Intellectual Ability and Sexual Recidivism Risk Assessment: Comparing Predictive Accuracy in an Incarcerated U.S. Sample.

While studies indicate that individuals with intellectual disabilities (ID) and borderline intellectual functioning (BIF) are overrepresented among those incarcerated for sexual offenses, there is a paucity of research with respect to risk assessment for this population, particularly among incarcerated U.S. samples. This gap is concerning given that individuals perceived as high risk may be denied bail, given harsher sentences, or subject to civil confinement. The present study examined the predictive validity of the Static-99 and Static-99R, which rely on historical predictors, and the MnSOST-R, which includes a dynamic subscale. Archival records were used to compare individuals with (n = 459) and without (n = 459) ID/BIF released from New Jersey state prisons between 1996 and 2007, with an average follow-up period of 5.7 years. All three instruments demonstrated good predictive validity for those without ID/BIF, while only the MnSOST-R produced a significant AUC value for those with ID/BIF. Reincarceration rates for those with ID/BIF within high-risk groups ranged from 0% to 8%, similar to the overall recidivism base rate of 4%. Results highlight the need for additional research to determine which risk factors should be considered for those with ID/BIF.

Forensic criteria, clinical and theoretical issues of the indication of court-ordered treatment: A comparative survey among experts in forensic psychiatry and sentencing judges in France.

Following the French law n° 98-468 of 17 June 1998 relative to the prevention of sexual offenses and the protection of minors, social and judicial follow-up and court-ordered treatment were introduced with the aim of reinforcing the prevention of recidivism. Court-ordered treatment is one of the possible obligatory measures provided for by social and judicial follow-up. However, there is no consensus between the different professionals concerning the criteria of indication and the final purpose of this measure. Most of the few available studies are retrospective. Only rare studies have assessed the influence of criminological factors on the indication of court-ordered treatment. We carried out a nation-wide qualitative comparative study in two populations, psychiatric experts and sentencing judges, by means of e-mail questionnaires. The aim was to determine the criteria for court-ordered treatment according to psychiatric experts and to sentencing judges, to identify the criteria that gave rise to differences in appreciation between these professionals, and to attempt to explain these differences. The secondary aim of the study was to determine the methods and tools used in expert practice to evaluate dangerousness and risk of recidivism. We obtained 20 responses in each of the two populations. The great majority of psychiatric experts and sentencing judges considered that court-ordered treatment was appropriate when the offender presented with psychiatric dangerousness, and so with an underlying mental disorder. When a subject had no identified mental disorder, the psychiatrists were divided in their opinion, whereas the majority of sentencing judges were in favor of court-ordered treatment. Opinions differed particularly significantly between the two populations in four circumstances: a subject with an antisocial/psychopathic personality disorder, a subject who denied the alleged acts, the influence of precarious social circumstances and the influence of instability in intimate relationships. The majority of experts used international classifications (DSM-5 and ICD-10) as a basis for their psychiatric diagnosis. Just under half of those surveyed used structured or semi-structured interview guides and only a few stated that they used standardized actuarial tools to assess risk of recidivism. The concepts of care, dangerousness and mental disorder are associated with multiple representations that certainly play a part in the disagreements between the different professionals. It is of prime importance to define these concepts more clearly in order to encourage the use of a common language and to clarify the indications and purpose of court-ordered treatment. We also hypothesize that disagreements between professionals regarding the criteria for court-ordered treatment may be related to certain difficulties raised by the management of the convicted person. The development of guidelines that could be used by all professionals would help to reduce some of these difficulties. Psychiatric experts remain attached to clinical evaluation. Their limited use of assessment tools may relate to the material constraints and time constraints involved. The issue at stake in court-ordered treatment and social and judicial follow-up is to promote cooperation between the various professionals by creating a space for exchange of ideas where the fundamental questions raised by these measures can be discussed, fears shared and knowledge pooled.

Explaining the Unexplainable: Balancing Responsibility, Expectations, and Identity in Narratives of Sexual Recidivism.

When someone is caught and punished for a sexual offense, recidivism prevention is of high priority. While a growing body of qualitative research has investigated the desistance process of those who have sexually offended, few studies have examined the narratives of individuals who have sexually recidivated in order to understand how they make sense of their reoffending. This study aims to fill this gap in the literature by exploring the recidivism process and broader life stories of 16 imprisoned men through semi-structured interviews. The results demonstrate how these men explain their recent "failures," the obstacles they face when doing so, and how they attempt to overcome these obstacles in their narratives. Thus, the analysis in this study is both thematic and narrative. Finally, the findings' practical implications are discussed to show how ambiguity in narratives can be a powerful tool in correctional and clinical interventions.

Reducing risk factors for child maltreatment: The Parenting-STAIR open pilot study.

BACKGROUND: Despite a large body of evidence linking the impact of trauma, parenting, and child maltreatment recidivism, current child welfare services often do not target maternal trauma and post-traumatic stress disorder (PTSD). Moreover, there is little evidence that traditional family preservation services (FPS) lower the rates of repeat incidences of child abuse and neglect. The novel intervention, Parenting-STAIR (P-STAIR), seeks to address maternal mental health and parenting skills in order to reduce punitive parenting behaviors. OBJECTIVE: This study analyzes the effects of P-STAIR on child maltreatment risk. PARTICIPANTS AND SETTING: P-STAIR was administered to 112 child welfare-involved mothers in New York City (NYC). The mothers were between 18 and 52 years old (M = 31.1, SD = 6.6) and were referred from 4 child welfare preventive service agencies in NYC. METHODS: To evaluate change over time in indicators of maltreatment risk, two-tailed paired sample t-tests compared 1) pre- and post-treatment scores and 2) pre-treatment and 3-month follow-up scores. RESULTS: Among the 71 mothers who completed treatment, significant improvements from baseline to post-assessment and pre- to 3-month follow-up were observed across total scores on the CTSPC and the AAPI-2. Improvements were evident in nonviolent disciple, psychological aggression, expectations, empathy, and parent-child family roles at both the post-assessment and 3-month follow-up which are proximal outcomes of P-STAIR (CTSPC: pre-post nonviolent disciple d = 0.70; pre-post psychological aggression d = 0.34; pre-follow-up nonviolent disciple d = 0.42; pre-follow-up psychological aggression d = 0.36; AAPI-2; pre-post expectations d = 0.31; pre-post empathy d = 0.39; pre-post parent-child roles d = 0.47; pre-follow-up expectations d = 0.33; pre-follow-up empathy d = 0.42; pre-follow-up parent-child roles d = 0.66). CONCLUSIONS: The improvement in indicators of maltreatment risk demonstrates promising support for the utility of P-STAIR within the child welfare system.

The Risk for Readmission to Juvenile Detention: The Role of Trauma Exposure and Trauma-related Mental Health Disorders.

The purpose of this study was to examine the impact of childhood trauma exposure, posttraumatic stress disorder, and trauma-related comorbid diagnoses on the risk for readmission to juvenile detention among youth in a large metropolitan area (N = 1282). The following research questions were addressed: 1) Does a greater number of childhood traumas increase the risk for readmission to detention following release? 2) Does the risk for readmission differ by type of trauma? 3) Do PTSD and other co-morbid diagnoses increase the risk for readmission? and 4) What role do demographic factors play in the relationship between trauma-related variables and risk for readmission? This study utilized the screening results of 1282 youth who were voluntarily screened for PTSD, depressive symptoms and substance use during their initial intake to detention. More than half of the sample was readmitted during the three-year study period, with readmissions most likely to occur within one year of release. Returning to detention within one year was also associated with increased risk for multiple readmissions. Youth readmitted to detention were more likely to have a history of sexual abuse and problematic substance use. No other significant relationships were found between risk for readmission and trauma-related variables. Although trauma-related symptoms may be crucial targets for treatment, focusing solely on trauma exposure and traumatic stress symptoms without considering the impact of other risk factors may not be enough to decrease the likelihood of readmission for youth of color in a large urban environment.

Clinical Characteristics of Offspring Born to Parents with Type 2 Diabetes Diagnosed in Youth: Observations from TODAY.

Diabetes exposure during pregnancy affects health outcomes in offspring; however, little is known about in utero exposure to preexisting parental youth-onset type 2 diabetes. Offspring born to participants during the Treatment Options for Type 2 Diabetes in Adolescent and Youth (TODAY) study were administered a questionnaire at the end of the study. Of 457 participants, 37% of women and 18% of men reported 228 offspring, 80% from female participants. TODAY mothers had lower household income (<$25,000) compared to TODAY fathers (69.4% vs. 37.9%, p = 0.0002). At 4.5 years of age (range 0-18 years), 16.7% of offspring were overweight according to the parental report of their primary care provider, with no sex difference. Offspring of TODAY mothers reported more daily medication use compared to TODAY fathers (50/183, 27.7% vs. 6/46, 12.2%, [p = 0.04]), a marker of overall health. TODAY mothers also reported higher rates of recidivism (13/94) than TODAY fathers (0/23). An Individualized Education Plan was reported in 20/94 (21.3%) offspring of TODAY mothers compared to 2/23 (8.7%) of TODAY fathers. This descriptive study, limited by parental self-reports, indicated offspring of participants in TODAY experience significant socioeconomic disadvantages, which, when combined with in utero diabetes exposure, may increase their risk of health and educational disparities.

Examining the Past Injustices Suffered by Those in Corrections and the General Public: A New Therapeutic Approach May Be Necessary.

One under-researched area within corrections is the connection among (a) past adverse events, particularly in the form of injustices against those who now are incarcerated, (b) crimes committed and then (c) healing from the effects of that past adversity of injustice. Might those who have experienced severe injustices against them develop an anger or a hatred that then is displaced onto others, leading to arrest, conviction and imprisonment? This is not to imply that societies condone illegal behaviour but instead to assist in the healing from the adversity so that future crime is reduced. As a first step in this sequence, the study here examined in detail the kinds of injustices suffered by men in a maximum-security correctional institution (N = 103) compared with men in a medium-security environment (N = 37) and in the general public (N = 96). Findings indicated differences between those in the general public and those in the two correctional contexts. The latter two groups had (a) a higher severity of injustices against them (rated by a panel of researchers), (b) a more negative current impact that past injustices are having on them (also rated by a panel of researchers), (c) more reports that the injustices contributed to their choices to harm others, (d) more serious types of hurt (such as sexual abuse), (e) a stronger degree of self-reported hurt and (f) more injustices from family members. Implications for correctional rehabilitation to reduce the negative psychological effects caused by the injustices of others are discussed.

Safety First! Residential Group Climate and Antisocial Behavior: A Multilevel Meta-analysis.

A systematic review and multilevel meta-analysis was performed (28 studies and 313 effect sizes) on the relation between residential group climate (i.e., safety, atmosphere, repression, support, growth, structure) and antisocial behavior, including aggression and criminal recidivism. A systematic search was conducted in PsychINFO, ERIC, and OVID Medline up to February 2023. Results showed a small but significant association (r = .20) between residential group climate and antisocial behavior, equivalent to a 23% reduction of antisocial behavior in all clients receiving care in a residential facility with a therapeutic group climate. Moderator analyses showed that experienced safety was more strongly related to antisocial behavior (r = .30) than the other dimensions of group climate (.17 < r < .20), while the effect size was somewhat larger for adults (r = .24) than for youth (r = .15). We conclude that residential facilities should consider safety as a priority and should involve clients in a positive process of change through the development of a therapeutic environment and delivery of evidence-based treatment, addressing their needs from the perspective of rehabilitation.

The impact of testosterone-lowering medication on recidivism in individuals convicted of sexual offenses.

INTRODUCTION: Treatment of individuals who have committed sexual offences with Testosterone-Lowering Medication (TLM) is a comparatively intrusive kind of intervention, which regularly takes place in coercive contexts. Thus, the question of efficacy, but also the question of who should be treated, when and for how long, are of great importance. METHODS: Recidivism rates of TLM-treated high-risk individuals (+TLM; n = 54) were compared with high-risk individuals treated with psychotherapy only in the same forensic outpatient clinic (-TLM; n = 79). RESULTS: Group differences suggested a higher initial risk of + TLM (e.g. higher ris-assessment, previous convictions). Despite the increased risk, after an average time at risk of six years, +TLM recidivated significantly less often and significantly later than - TLM (27.8% vs. 51.9%). Such an effect was also found for violent (1.9% vs. 15.2%), but not for sexual (5.6% vs. 10.1%) and serious recidivism (5.6% vs. 10.1%), which could be explained partly by the small number of cases. In the course of treatment, TLM proved to be a significant variable for a positive process, whereas a high risk-assessment score indicated a rather negative course. In total, n = 19 individuals had stopped their TLM treatment, of these 31.6% recidivated. CONCLUSION: The results support the efficacy of TLM, particularly in the group of high-risk offenders.

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.

Impact of opioid maintenance therapy in the community on re-incarceration in individuals with opioid use disorder-A linked cohort study.

INTRODUCTION: Studies have found associations between Opioid Agonist Maintenance Treatment during incarceration and reduced recidivism among recently released formerly incarcerated persons. However, the role of community-based Opioid Agonist Maintenance Treatment in reducing recidivism post-release remains less explored. This study examines whether pre-release arranged, prison-to-rehabilitation Opioid Agonist Maintenance Treatment in the community following release is associated with reduced rates and lengths of re-incarceration among justice-involved individuals with Opioid Use Disorder. METHODS: A retrospective matched cohort study was conducted using linked records of 208 individuals with a history of Opioid Use Disorder and treatment during their incarceration. The primary predictor variable was the duration of Opioid Agonist Maintenance Treatment, with re-incarceration rates and lengths of stay after re-incarceration being the primary outcomes examined. RESULTS: Analysis showed a significant decrease in re-incarcerations and or lengths of stay in prison among those who have been re-incarcerated and have undergone Opioid Agonist Maintenance Treatment in the community for >24 months. CONCLUSIONS: Maintaining Opioid Agonist Maintenance Treatment over 24 months may reduce re-incarcerations, and may be significantly associated with a reduction in the length of prison stay for re-incarcerated individuals. The effects were consistent across the overall population and the individuals receiving the treatment. Various other unmeasured factors, including judicial discretion, individual motivation, type of offense, and employment status, could influence this association.

The effects of aftercare/resettlement services on crime and violence in children and youth: A systematic review.

Background: High rates of youth re-offending indicate that young custody-leavers face challenges when reintegrating into their communities. Aftercare and resettlement programs can occur pre-, during, and post-release and generally provide multiple forms of support services to address youths' transitional needs. Objectives: The present review examines (1) the impact of youth aftercare/resettlement programs on crime-related outcomes, (2) how treatment effect is moderated by participant, program, and study characteristics, (3) whether some types of interventions are more effective than others, (4) barriers/facilitators to effective program implementation, (5) the theory of change underlying resettlement interventions, and (6) available research on intervention cost. Search Methods: A comprehensive set of keywords and synonyms was combined in a Boolean search across 26 electronic databases. Multiple gray literature sources were also searched, including 23 journals, 4 meeting archives, 11 organization websites, 3 open access journal websites, and the CVs of 8 well-known researchers in the field. The search was completed in January 2023. Selection Criteria: For objectives 1-3, studies were included if they utilized a randomized controlled design or quasi-experimental comparison group design in which participants were matched on at least some baseline variables and included at least one quantitative individual-measure of crime. For objective 4, included studies presented process evaluations of aftercare/reentry programs, clearly stated their research goals, and used qualitative methods in an appropriate way to answer the stated research question. For objectives 5 and 6, no specific methods were required; any study meeting the criteria for objectives 1-4 which presented findings on theory of change or cost data were included. For all outcomes, only studies conducted in a westernized country, and published after 1991 in English, French, or German were considered. Data Collection and Analysis: Two coders conducted primary data extraction for the included studies. Data were entered into a Microsoft Excel database. After data extraction, the two coders validated the coding by cross-checking the database with each research report. Discrepancies between coders were discussed until consensus was reached. Where consensus could not be reached, a third coder was consulted. Study risk of bias was addressed using the ROBINS-I (Sterne et al., 2016), ROB-2 (Higgins et al., 2019), and the critical appraisal skills programme (CASP, 2018). Objectives 1-3 were addressed by synthesizing quantitative outcomes from rigorous impact evaluations of aftercare interventions using random effects models and meta-regression. Thematic and narrative analysis was conducted to address objectives 4-6. Results: The search resulted in 15 impact studies, representing 4,718 participants across 21 program sites, and 35 effect sizes. The 21 impact evaluations were rated as having either low/moderate bias (k = 11) or serious bias (k = 10). The synthesis of 15 impact studies found no significant effects for arrest (k = 14; OR = 1.044, 95% prediction interval [0.527, 2.075], t = 0.335) or incarceration (k = 8, OR = 0.806, 95% prediction interval [2.203, 1.433], t = -1.674). A significant pooled effect was found for conviction (k = 13, OR = 1.209, 95% prediction interval [1.000, 1.462], t = 2.256), but results were highly sensitive to the inclusion of specific studies. No meaningful pattern of results emerged in moderator analyses with respect to study, sample, program component, or program delivery characteristics. The 19 process studies were rated as either high quality (k = 12) or moderate quality (k = 7). Thematic synthesis of the process evaluations revealed 15 themes related to the strengths/challenges of program implementation. The assessment of program cost (k = 7) determined a lack of data within the literature, preventing any summative analysis. Authors' Conclusions: Current evidence is promising with respect to conviction outcomes but overall does not find that aftercare/resettlement interventions have a reliably positive impact on crime-related outcomes for young people who have offended. High variability across outcomes and reported data resulted in small sample sizes per outcome and limited moderator analyses. Multiple challenges for program implementation exist; additional rigorous research is sorely needed to further investigate the nuances of the program effects.

A Qualitative Systematic Review of the Barriers and Facilitators of the Reintegration of Men Convicted of a Sexual Offense From Prison or Secure Care into the Community.

This article is the first qualitative systematic review of studies examining the barriers and facilitators to male sex offenders reintegration from prison or secure care into the community. A search of 16 electronic databases produced 14,218 potential sources, which, after screening, resulted in 79 articles for inclusion. Papers were included if they used qualitative research methods about the barriers, facilitators, perceptions, experiences, and attitudes toward community reintegration from prison or secure care for men convicted of sexual offenses. Included papers were critically appraised and the findings were thematically synthesized. The findings identified that formal and cultural aspects of reintegration, such as probation services, stigmatization, and registration, were the three largest barriers that men faced upon their release, with stability aspects, such as positive relationships, religion, and support groups, being key facilitators to their successful reintegration. The implications for future research, and policy and practice, including prioritizing risk assessment and management, offering appropriate and timely treatment and rehabilitation, educating the community, better access to housing and employment, and services adopting a collaborative approach, are discussed.

Characteristics of Patients Who Return to the Emergency Department After an Observation Unit Assessment.

Introduction: Emergency Department observation units (EDOU) transition patients from the emergency department (ED) to dedicated areas where they can receive continuous monitoring. Understanding patient return visits after EDOU discharge is important for optimizing healthcare. The objective of this study was to investigate the correlation between demographic and clinical features and the likelihood of returning to the ED within 30 days following their initial assessment in the EDOU. Methods: This retrospective, observational cohort study of adult EDOU subjects was conducted between February 1, 2018 - January 31, 2023. Adult patients evaluated in the EDOU and returned to the ED within 30 days were identified. Subjects were compared to those assessed in the EDOU but did not return to the ED within 30 days. The analysis took into account multiple visits by the same subject and made adjustments for variables including gender, ethnicity, insurance status, primary diagnosis, and disposition, using a generalized linear mixed model. Results: A total of 14,910 EDOU encounters were analyzed and 2,252 (15%) patients returned to the ED within 30 days. The analysis took into account several variables demonstrated a significant association with the likelihood of returning to the ED within 30 days. These included gender (p=0.0002), ethnicity (p=0.005), race (p=0.0004), insurance status (p<0.0001), primary diagnosis (p<0.0001), and disposition (p<0.001). Emergency severity index and length of stay were not associated with returning. Conclusions: Understanding these factors may guide interventions, enhance EDOU care, and reduce resource strain. Further research should explore these associations and long-term intervention impacts for improved outcomes.