Health outcomes and cost-effectiveness of diversion programs for low-level drug offenders: A model-based analysis.

BACKGROUND: Cycles of incarceration, drug abuse, and poverty undermine ongoing public health efforts to reduce overdose deaths and the spread of infectious disease in vulnerable populations. Jail diversion programs aim to divert low-level drug offenders toward community care resources, avoiding criminal justice costs and disruptions in treatment for HIV, hepatitis C virus (HCV), and drug abuse. We sought to assess the health benefits and cost-effectiveness of a jail diversion program for low-level drug offenders. METHODS AND FINDINGS: We developed a microsimulation model, calibrated to King County, Washington, that captured the spread of HIV and HCV infections and incarceration and treatment systems as well as preexisting interventions such as needle and syringe programs and opiate agonist therapy. We considered an adult population of people who inject drugs (PWID), people who use drugs but do not inject (PWUD), men who have sex with men, and lower-risk heterosexuals. We projected discounted lifetime costs and quality-adjusted life years (QALYs) over a 10-year time horizon with and without a jail diversion program and calculated resulting incremental cost-effectiveness ratios (ICERs) from the health system and societal perspectives. We also tracked HIV and HCV infections, overdose deaths, and jail population size. Over 10 years, the program was estimated to reduce HIV and HCV incidence by 3.4% (95% CI 2.7%-4.0%) and 3.3% (95% CI 3.1%-3.4%), respectively, overdose deaths among PWID by 10.0% (95% CI 9.8%-10.8%), and jail population size by 6.3% (95% CI 5.9%-6.7%). When considering healthcare costs only, the program cost $25,500/QALY gained (95% CI $12,600-$48,600). Including savings from reduced incarceration (societal perspective) improved the ICER to $6,200/QALY gained (95% CI, cost-saving $24,300). Sensitivity analysis indicated that cost-effectiveness depends on diversion program participants accessing community programs such as needle and syringe programs, treatment for substance use disorder, and HIV and HCV treatment, as well as diversion program cost. A limitation of the analysis is data availability, as fewer data are available for diversion programs than for more established interventions aimed at people with substance use disorder. Additionally, like any model of a complex system, our model relies on simplifying assumptions: For example, we simplified pathways in the healthcare and criminal justice systems, modeled an average efficacy for substance use disorder treatment, and did not include costs associated with homelessness, unemployment, and breakdown in family structure. CONCLUSIONS: We found that diversion programs for low-level drug offenders are likely to be cost-effective, generating savings in the criminal justice system while only moderately increasing healthcare costs. Such programs can reduce incarceration and its associated costs, and also avert overdose deaths and improve quality of life for PWID, PWUD, and the broader population (through reduced HIV and HCV transmission).

Effectiveness of a Modular Cognitive-Behavioral Skills Curriculum in High-Risk Justice-Involved Youth.

The aim of this study was to evaluate the effectiveness of a flexible modular cognitive-behavioral theory (CBT) skills curriculum delivered by paraprofessionals in a community organization targeting high-risk justice-involved youth. Programmatic data were collected from 980 high-risk young men (Mage, 21.12; SD, 2.30), and Cox proportional hazards regression was used. The results showed that compared with young men with no CBT encounters, those with one or more CBT encounters had a 66% (hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.28-0.42; p < 0.001) lower risk of unenrolling from programming, 65% (HR, 1.65; 95% CI, 1.29-2.12; p < 0.001) higher risk of obtaining a job, and no difference in risk of engaging in new criminal activity while enrolled in programming (HR, 0.99; 95% CI, 0.78-1.25; p = 0.918), despite higher risk factors. Training paraprofessionals to deliver CBT skills to high-risk populations is effective and has scalability potential.

Receipt of training about medication for opioid use disorder from pharmaceutical manufacturers: A preliminary study of Florida criminal problem-solving and dependency court staff.

INTRODUCTION AND AIMS: People with opioid use disorder are prevalent in criminal problem-solving courts and dependency courts, which have rehabilitative aims. Medication for opioid use disorder (MOUD) is the standard of care. Court staff set treatment policies for court clients. They may receive training from MOUD manufacturers, but no studies have examined court staff receipt of such training. DESIGN AND METHODS: To examine receipt of training from MOUD manufacturers, we designed a cross-sectional survey for court staff. We distributed it online to all Florida court staff in criminal problem-solving or dependency courts (n = 585). Outcome variables were receipt of training from one or more MOUD manufacturers and training source. Covariates included dichotomous measures of court type, staff role, gender and rurality. Logistic regression models estimated the relationship between receipt of training and covariates. RESULTS: Twenty-one percent of Florida criminal problem-solving and dependency court staff completed the survey. The most common receipt of training was from the manufacturer of extended-release naltrexone (36%), followed by buprenorphine (24%) and methadone (11%). Fifty-seven percent of those who received training received it from more than one MOUD manufacturer. Criminal problem-solving court staff were more likely than dependency court staff to receive training from MOUD manufacturers. Court program co-ordinators were more likely than other staff roles to receive training from MOUD manufacturers. DISCUSSION AND CONCLUSIONS: A large minority of respondents received training from a MOUD manufacturer, primarily from extended-release naltrexone's manufacturer, raising concerns regarding information accuracy and conflicts of interest. Court staff should seek MOUD training from academic institutions and non-profit organisations instead.

The impact of changes to the NSW graduated driver licensing system on subsequent crash and offense experience.

INTRODUCTION: In mid-2007 the State of New South Wales (NSW) in Australia introduced modifications to the existing graduated driver licensing system, lengthening the mandatory number of supervised hours for learner drivers aged under 25 years from 50 to 120 and extending the minimum learner period from 6 to 12 months. Additional driving restrictions were also introduced for young drivers in the two provisional licensed periods, P1, P2. This paper aims to evaluate this change by comparing the crash and offense experiences of young learner drivers before and after it occurred. METHOD: From driver licensing files supplied by the NSW transport authority two cohorts of persons obtaining their initial learner's permits in the year prior to the changes and in the subsequent year were constructed with demographic data, dates of transition to the driving phases, dates of crashes, and dates and types of traffic offenses. Both cohorts comprised around 100,000 individuals. Crash rates per 100 years of person-time under observation post P1 with their standard errors were calculated. Using a survival-analytic approach the proportion of crashes of all types were graphed in three month periods post P1. Sexes were treated separately as were initial learner ages of 16, 17, 18-21, and 22-24 years. The distribution of traffic offense types during P1 and P2 phases were also compared. With such large numbers formal statistical testing was avoided. RESULTS: No meaningful differences in the crash or offense experiences of the two cohorts in either sex or at any age were observed. Delaying progress to unsupervised driving has road safety benefits. CONCLUSIONS: At least in conditions similar to those in NSW, requiring more than 50 h of supervised driving seems to have few road safety benefits. Practical applications: Licensing authorities should be cautious in extending the mandated number of supervised driving hours beyond 50.

Using Theory to Understand the Barriers to Engagement in Group Offending Behavior Programs.

Noncompletion of group offending behavior programs is a common problem, indicating barriers to engagement. While existing theoretical models have accounted for determinants of motivation, little focus has been directed towards barriers to engagement. The authors developed the program engagement theory (PET) which not only accounts for the determinants of engagement and the engagement process, it also considers the barriers to engagement. Interviews and session observations were used to collect data from 23 program facilitators and 28 offenders, which were analyzed using grounded theory. The barriers to engagement were classified as program and referral factors (uninformative referrals, offense-focused programs, rigid and abstract content, didactic delivery, and homework), facilitator characteristics (lack of control: contentious and nonassertive), and group member characteristics (unmotivated, pre-contemplative, and blaming others and young, chaotic, and disruptive). Suggestions as to the design and facilitation of group offending behavior programs, and facilitator training and supervision to overcome barriers to engagement are proposed.

Adult Connection in Assault Injury Prevention among Male Youth in Low-Resource Urban Environments.

Strengths-based strategies to reduce youth violence in low-resource urban communities are urgently needed. Supportive adolescent-adult relationships may confer protection, but studies have been limited by self-reported composite outcomes. We conducted a population-based case-control study among 10- to 24-year-old males in low-resource neighborhoods to examine associations between supportive adult connection and severe assault injury. Cases were victims of gunshot assault injury (n = 143) and non-gun assault injury (n = 206) from two level I trauma centers. Age- and race-matched controls (n = 283) were recruited using random digit dial from the same catchment. Adolescent-adult connections were defined by: (1) brief survey questions and (2) detailed family genograms. Analysis used conditional logistic regression. There were no significant associations between positive adult connection, as defined by brief survey questions, and either gunshot or non-gun assault injury among adolescents with high prior violence involvement (GSW OR = 2.46, 95% CI 0.81-7.49; non-gun OR = 1.59, 95% CI 0.54-4.67) or low prior violence involvement (GSW OR = 0.92, 95% CI 0.34-2.44; non-gun OR = 1.96, 95% CI 0.73-5.28). In contrast, among adolescents with high levels of prior violence involvement, reporting at least one supportive adult family member in the family genogram was associated with higher odds of gunshot assault injury (OR = 4.01, 95% CI 1.36-11.80) and non-gun assault injury (OR = 4.22, 95% CI 1.48-12.04). We were thus unable to demonstrate that positive adult connections protected adolescent males from severe assault injury in this highly under-resourced environment. However, at the time of injury, assault-injured adolescents, particularly those with high prior violence involvement, reported high levels of family support. The post-injury period may provide opportunities to intervene to enhance and leverage family connections to explore how to better safeguard adolescents.

High uptake of naloxone-based overdose prevention training among previously incarcerated syringe-exchange program participants.

BACKGROUND: Incarceration is common among people who inject drugs. Prior research has shown that incarceration is a marker of elevated risk for opioid overdose, suggesting that the criminal justice system may be an important, under-utilized venue for implementing overdose prevention strategies. To better understand the feasibility and acceptability of such strategies, we evaluated the utilization of naloxone-based overdose prevention training among people who inject drugs with and without a history of incarceration. METHODS: We surveyed clients who utilize a multi-site syringe exchange program (SEP) in 2 cities in the Midwestern United States. Participants completed an 88-item, computerized survey assessing history of incarceration, consequences associated with injection, injecting practices, and uptake of harm reduction strategies. RESULTS: Among 543 respondents who injected drugs in the prior 30 days, 243 (43%) reported prior incarceration. Comparing those with and without a history of incarceration, there were no significant differences with respect to age, gender, or race. Those who observed an overdose, experienced overdose, and received training to administer or have administered naloxone were more likely to report incarceration. Overall, 69% of previously incarcerated clients had been trained to administer naloxone. CONCLUSION: People who inject drugs with a history of incarceration appear to have a higher risk of opioid overdose than those never incarcerated, and are more willing to utilize naloxone as an overdose prevention strategy. Naloxone training and distribution is an important component of comprehensive prevention services for persons with opioid use disorders. Expansion of services for persons leaving correctional facilities should be considered.

Social and health care professionals' views on responsible agency in the process of ending intimate partner violence.

This article examines social and health care professionals' views, based on their encounters with both victims and perpetrators, on the division of responsibility in the process of ending intimate partner violence. Applying discourse analysis to focus group discussions with a total of 45 professionals on solutions to the problem, several positions of responsible agency in which professionals place themselves and their clients are identified. The results suggest that one key to understanding the complexities involved in violence intervention lies in a more adequate theorization of the temporal and intersubjective dimensions of the process of assigning responsibility for the problem.

[Socio-demographic, clinical and criminological features of a population discharged from forensic hospital and admitted to neuropsychiatric clinic, in scheme of restriction of freedom]. / Caratteristiche socio-demografiche, cliniche e criminologiche di una popolazione di pazienti dimessi dall'ospedale psichiatrico giudiziario, in regime di restrizione della libertà, ricoverati presso una clinica neuropsichiatrica.

INTRODUCTION: Over the past twenty years, in Italy there has been an intense debate that has focused on the function, and overcoming the limits of the institution Judicial Psychiatric Hospital (ospedale psichiatrico giudiziario - OPG). Although the contribution of legislative proposals, conferences and workshops on the OPG subject has received significant, the interest focused on the development and elaboration of criminological and epidemiological research on a national scale has been proportionately less impetum. In this study a survey aimed to explore the socio-demographic, clinical and criminological features of patients discharged from the OPG and admitted to neuropsychiatric clinic, under the restriction of freedom, has been performed. METHODS: The information was gathered at the time of entry in the clinical management, by means of the first clinical interview and during subsequent interviews. During hospitalization, patients were administered the Mini-Mental State Examination (MMSE) and K Axis (Axis V of Kennedy) questionaires. RESULTS: 23 patients from forensic hospitals of Aversa, Secondigliano and Castiglione delle Stiviere were included in the study. The main characteristics investigated delineate a profile of an individual with an average age of about 49 years, unmarried, from a low socio-economic context, unemployed at the time of internment. About the diagnosis, schizophrenic spectrum disorders prevail, there is history of substance abuse in 35% of cases, history of previous admission to psychiatric facilities in 87% of these subjects. The type of committed crimes regards crimes against the person. About 40% of individuals have exhausted the danger to society correlate at the time of admission. CONCLUSIONS: Despite the small sample size, the data from this study are consistent with those reported in few studies in the literature. The specificity of clinical care needs of mentally ill offenders requires greater definition that could be achieved through the development of this research area.

Effect of an injury awareness education program on risk-taking behaviors and injuries in juvenile justice offenders: a retrospective cohort study.

BACKGROUND: Risk-taking behavior is a leading cause of injury and death amongst young people. METHODOLOGY AND PRINCIPAL FINDINGS: This was a retrospective cohort study on the effectiveness of a 1-day youth injury awareness education program (Prevent Alcohol and Risk-related Trauma in Youth, P.A.R.T.Y.) program in reducing risk taking behaviors and injuries of juvenille justice offenders in Western Australia. Of the 3659 juvenile justice offenders convicted by the court magistrates between 2006 and 2010, 225 were referred to the P.A.R.T.Y. education program. In a before and after survey of these 225 participants, a significant proportion of them stated that they were more receptive to modifying their risk-taking behavior (21% before vs. 57% after). Using data from the Western Australia Police and Department of Health, the incidence of subsequent offences and injuries of all juvenile justice offenders was assessed. The incidence of subsequent traffic or violence-related offences was significantly lower for those who had attended the program compared to those who did not (3.6% vs. 26.8%; absolute risk reduction [ARR] = 23.2%, 95% confidence interval [CI] 19.9%-25.8%; number needed to benefit = 4.3, 95%CI 3.9-5.1; p = 0.001), as were injuries leading to hospitalization (0% vs. 1.6% including 0.2% fatality; ARR = 1.6%, 95%CI 1.2%-2.1%) and alcohol or drug-related offences (0% vs. 2.4%; ARR 2.4%, 95%CI 1.9%-2.9%). In the multivariate analysis, only P.A.R.T.Y. education program attendance (odds ratio [OR] 0.10, 95%CI 0.05-0.21) and a higher socioeconomic background (OR 0.97 per decile increment in Index of Relative Socioeconomic Advantage and Disadvantage, 95%CI 0.93-0.99) were associated with a lower risk of subsequent traffic or violence-related offences. SIGNIFICANCE: Participation in an injury education program involving real-life trauma scenarios was associated with a reduced subsequent risk of committing violence- or traffic-related offences, injuries, and death for juvenille justice offenders.

The limits of oral history: ethics and methodology amid highly politicized research settings.

In recent years, oral history has been celebrated by its practitioners for its humanizing potential, and its ability to democratize history by bringing the narratives of people and communities typically absent in the archives into conversation with that of the political and intellectual elites who generally write history. And when dealing with the narratives of ordinary people living in conditions of social and political stability, the value of oral history is unquestionable. However, in recent years, oral historians have increasingly expanded their gaze to consider intimate accounts of extreme human experiences, such as narratives of survival and flight in response to mass atrocities. This shift in academic and practical interests begs the questions: Are there limits to oral historical methods and theory? And if so, what are these limits? This paper begins to address these questions by drawing upon fourteen months of fieldwork in Rwanda and Bosnia-Hercegovina, during which I conducted multiple life history interviews with approximately one hundred survivors, ex-combatants, and perpetrators of genocide and related mass atrocities. I argue that there are limits to the application of oral history, particularly when working amid highly politicized research settings.

"Stones run it": taking back control of organized crime in Chicago, 1940-1975.

In the 1960s and 1970s African American "supergangs" emerged in Chicago. Many scholars have touted the "prosocial" goals of these gangs but fail to contextualize them in the larger history of black organized crime. Thus, they have overlooked how gang members sought to reclaim the underground economy in their neighborhoods. Yet even as gangs drove out white organized crime figures, they often lacked the know-how to reorganize the complex informal economy. Inexperienced gang members turned to extreme violence, excessive recruitment programs, and unforgiving extortion schemes to take power over criminal activities. These methods alienated black citizens and exacerbated tensions with law enforcement. In addition, the political shelter enjoyed by the previous generation of black criminals was turned into pervasive pressure to break up street gangs. Black street gangs fulfilled their narrow goal of community control of vice. Their interactions with their neighbors, however, remained contentious.

Criminal sittings ­ rape in the colony, New Zealand, 1862.

In 1862 His Honor, Justice Johnston, issued his instructions to the jury of the New Zealand Supreme Court for two simultaneous rape trials ­ the alleged rape of a European woman by two Maori men, and an alleged "assault with intent to commit a rape" of a Maori woman by a European man. This article argues that those instructions should be read within an historiographical critique of British colonial expansion, print capitalism and violence. Drawing on feminist postcolonial theorizing the question posed here, is, "What is the historical, ideological context for a newspaper reporting of the possible rape of a Maori woman in 1862?

Research notes from the underworld: the entry logs of the Rio de Janeiro Casa de Detenção, 1860-1969.

The Rio de Janeiro state archive's collection of entry logs for the city's central detention center, going back to the mid-nineteenth century, provides a rare glimpse into the lives of Rio's­and Brazil's­poor and working classes who otherwise left few written records behind. During the time when the institution maintained the entry logs, police exercised broad power to make arrests. Although relatively few detainees were ever prosecuted or even formally charged, the detention center kept detailed records of detainees' physical appearance, attire, home address, nationality, sex, affiliation, and so on, as well as information about any criminal charges. This article explores the wealth of empirical data that the entry logs provide. It also suggests how scrutinizing this type of document across time shows how record keeping itself changed, in turn affording researchers rare insight into the inner workings of modern Latin American society.

Direct and vicarious violent victimization and juvenile delinquency: an application of general strain theory.

Using a national probability sample of adolescents (12­17), this study applies general strain theory to how violent victimization, vicarious violent victimization, and dual violent victimization affect juvenile violent/property crime and drug use. In addition, the mediating effect and moderating effect of depression, low social control, and delinquent peer association on the victimization­delinquency relationship is also examined. Based on SEM analyses and contingency tables, the results indicate that all three types of violent victimization have significant and positive direct effects on violent/property crime and drug use. In addition, the expected mediating effects and moderating effects are also found. Limitations and future directions are discussed.

Crime, shame, reintegration, and cross-national homicide: a partial test of reintegrative shaming theory.

Reintegrative shaming theory (RST) argues that social aggregates characterized by high levels of communitarianism and nonstigmatizing shaming practices benefit from relatively low levels of crime. We combine aggregate measures from the World Values Survey with available macro-level data to test this hypothesis. Additionally, we examine the extent to which communitarianism and shaming mediate the effects of cultural and structural factors featured prominently in other macro-level theoretical frameworks (e.g., inequality, modernity, sex ratio, etc.). Findings provide some support for RST, showing homicide to vary with societal levels of communitarianism and informal stigmatization. However, while the effects of modernity and sex ratio were mediated by RST processes, suppression was indicated for economic inequality. Implications for theory and research are discussed.

Watching the detectives: crime programming, fear of crime, and attitudes about the criminal justice system.

Research demonstrates a complex relationship between television viewing and fear of crime. Social critics assert that media depictions perpetuate the dominant cultural ideology about crime and criminal justice. This article examines whether program type differentially affects fear of crime and perceptions of the crime rate. Next, it tests whether such programming differentially affects viewers' attitudes about the criminal justice system, and if these relationships are mediated by fear. Results indicated that fear mediated the relationship between viewing nonfictional shows and lack of support for the justice system. Viewing crime dramas predicted support for the death penalty, but this relationship was not mediated by fear. News viewership was unrelated to either fear or attitudes. The results support the idea that program type matters when it comes to understanding people's fear of crime and their attitudes about criminal justice.

Familiarity, legitimation, and frequency: the influence of others on the criminal self-view.

From an identity theory perspective, reflected appraisals from others are relevant for social behavior, because behavior is motivated by the desire to achieve congruence between reflected appraisals and the self-view for a particular identity. This study extends prior identity theory work from the laboratory setting by examining identity processes with respect to the criminal identity in the unique "natural" setting of a total institution. The findings build on prior work which finds that reflected appraisals do have an influence on identities and behavior by demonstrating that the relationship one has to the source of reflected appraisals is important for the way in which reflected appraisals influence the criminal self-view for an incarcerated population.

Forced disappearance in an era of globalization: biopolitics, shadow networks, and imagined worlds.

In this article, I argue that the practice of forced disappearance of persons on the part of paramilitary groups has become linked to specific processes of globalization. Global flows related to biopolitics, global crime networks, and dehumanizing imaginations reproduced by mass media together constitute a driving force behind forced disappearances. Drawing on ethnographic fieldwork in the Colombian city of Medellín, I analyze how these global flows interact with local armed actors, helping create a climate conducive to forced disappearance. These mechanisms in Colombia show similarities to those in some African and Asian countries. Gaining insight into the mechanisms behind forced disappearance may help prevent it from occurring in the future. Enhancing social inclusion of residents, unraveling the transnational crime networks in which perpetrators are involved, and disseminating rehumanizing images of victims all contribute to curbing the practice of forced disappearance.