Maintaining disorder: estimating the association between policing and psychiatric hospitalization among youth in New York City by neighborhood racial composition, 2006-2014.

PURPOSE: To assess whether neighborhood-level measures of policing are spatio-temporally associated with psychiatric hospialization among adolescents and young adults in New York City, and whether this association varies by neighborhood racial composition. METHODS: We derived population-based measures of policing from the New York City Police Department (NYPD), psychiatric hospitalization from Statewide Planning and Research Cooperative System (SPARCS) data, and socio-demographic data from the American Community Survey (ACS), aggregated by month and ZIP Code Tabulation Area (ZCTA) from 2006 to 2014. Multi-level negative binomial regression models assessed hospitalization-time of youth aged 10-24 as the dependent variable and the rate of policing events as the primary independent variable, adjusting for neighborhood poverty, unemployment, and educational attainment. Multiplicative interaction was assessed between policing and tertiles of the percentage of Black residents. RESULTS: A total of 11,900,192 policing incidents and 2,118,481 person-days of hospitalization were aggregated to 19,440 ZCTA-months. After adjusting for neighborhood-level sociodemographic characteristics, an increase in one policing incident per 1,000 residents was associated with a 0.3% increase in the rate of youth psychiatric hospitalization time (IRR 1.003 [1.001-1.005]). Neighborhood racial composition modified this effect; not only was the rate of psychiatric hospitalization and policing higher in neighborhoods with a higher proportion of Black residents, but the association between these was also significantly higher in neighorhoods with a larger share of Black residents compared with predominantly non-Black neighborhoods. CONCLUSION: Neighborhoods experiencing higher rates of policing during the study period experienced higher burdens of psychiatric hospitalization among adolescent and young adult residents. This association was larger in neighborhoods of color which have been disproportionately targeted by "hot spot" and order-maintenance policing practices and policies.

Resident perspectives on a pre-booking diversion program.

Numerous cities are experimenting with pre-booking diversion programs that allow police officers to divert community members to supportive services in instances that would otherwise result in arrest and prosecution. These programs aim to decrease harmful involvement with the criminal justice system while reducing crime and public disorder. Although previous research has explored the experiences of people receiving diversion referrals and of police officers initiating them, none have examined the perspectives of community members who can offer crucial insights into planning, evaluation, and implementation barriers. We administered a survey to 293 people living in four police districts where the Philadelphia Police Department operates a pre-booking diversion program. The survey explored residents' perspectives on the program as well as their broader views on associated issues like decriminalization of substance use, sex work, and minor theft. Bivariate χ2 tests and multivariate logistic regression examined differences in responses between subgroups. Perspectives were diverse and varied based on demographic attributes of the respondents as well as on district level attributes, like crime patterns. Most surveyed community members perceived pre-booking diversion to be a valuable tool for improving the experiences and outcomes of policing. However, residents living in areas with more crime and with more public disorder held significantly less positive perspectives. Their skepticism may reflect the possibility that pre-booking diversion and similar reforms are necessary but not sufficient to transforming individual health and public safety in some areas.

Co-Deployment is an Answer, but What are the Questions? Insights from Officer Focus Groups in Philadelphia.

Cities have been experimenting with less police-centered models for responding to people experiencing mental health crises. Ten focus groups were conducted with Philadelphia police officers to understand their experiences encountering mental health distress in the community and their perspectives on a new co-deployment initiative. There was general consensus that conventional police-centered responses to mental health concerns are often problematic. However, perspectives varied on the value of co-deployment and the general feasibility of reducing police involvement. This variation is traced to different notions of what constitutes a mental health crisis, whether crises are prospectively identifiable, how dangerousness is assessed, and whether civilian co-response partners will effectively complete key response activities. Bringing greater understanding and consensus to these issues is essential to healthier and more effective responses to mental health crises.

A Need for More Research: How to Understand Elevated Rates of Sexual Assault Among Bisexual College Women.

Bisexual college women exhibit some of the highest rates of sexual assault among all college students. Existing research relies on sexual orientation-related stigma as an explanation for these disparities. In this study, we use data from the Online College Social Life Survey (OCSLS) to explore factors that elevate the risk of sexual assault for bisexual college women compared to heterosexual women. Results show that bisexual women exhibit higher rates of sexual assault since the beginning of college for all types of sexual assault, compared to heterosexual women. We find that perceived sexual disrespect, sexual interactions with men, alcohol use, earlier sexual debut, and multiple ongoing partnerships are associated with a higher risk of sexual assault for both bisexual and heterosexual women. Compared to heterosexual women, bisexual women exhibited higher odds of experiencing sexual assault across the majority of risk factors. We envision this study as a preliminary exploration that can inform ongoing work examining which bisexual women are at the highest risk for sexual assault. Implications for future research and intervention are discussed.

Longitudinal relationships among exclusionary school discipline, adolescent substance use, and adult arrest: Public health implications of the school-to-prison pipeline.

PURPOSE: Exclusionary school discipline is an initiating component of the school-to-prison pipeline that is racialized and may lead to short- and long-term negative substance use and criminal legal outcomes. However, these impacts, and racial disparities therein, have not been well explored empirically at the individual-level. PROCEDURES: We analyzed data from the National Longitudinal Study of Adolescent to Adult Health (1995-2009). We fit survey-weighted multivariable logistic regression models to estimate reciprocal relationships between exclusionary discipline and adolescent substance use, between these factors and subsequent exposure to the adult criminal legal system, and whether these relationships were modified by race or ethnicity. RESULTS: We found that students reporting substance use had 2.07 (95% CI 1.57, 2.75) times greater odds of reporting subsequent school discipline, and students exposed to school discipline had 1.59 (95% CI 1.26, 2.02) times greater odds of reporting subsequent substance use. Substance use and school discipline were associated with 2.69 (95% CI 2.25, 3.22) and 2.98 (95% CI 2.46, 3.60) times the odds of reporting subsequent adult criminal legal system exposure, respectively. There was little evidence of effect modification by race/ethnicity. CONCLUSIONS: Findings indicate that school discipline and substance use are reciprocally associated and have direct implications for adolescent health and future criminal legal system exposure.

Collateral consequences of the school-to-prison pipeline: Adolescent substance use and developmental risk.

OBJECTIVE: The adolescent health consequences of the school-to-prison pipeline remain underexplored. We test whether initiating components of the school-to-prison pipeline-suspensions, expulsions, and school policing-are associated with higher school-average levels of student substance use, depressed feelings, and developmental risk in the following year. METHOD: We linked 2003-2014 data from the California Healthy Kids Survey and the Civil Rights Data Collection from over 4,800 schools and 4,950,000 students. With lagged multi-level models, we estimated relationships between the school prevalence of total discipline, out-of-school discipline, and police-involved discipline, and standardized school-average levels of 6 substance use measures and 8 measures of developmental risk, respectively. RESULTS: The prevalence of school discipline predicted subsequent school-mean substance use and developmental risk. A one-unit higher prevalence of total discipline predicted higher school levels (in standard deviations) of binge drinking alcohol (0.14, 95% CI: 0.11, 0.17), drinking alcohol (0.15, 95% CI: 0.12, 0.18), smoking tobacco (0.09, 95% CI: 0.06, 0.12), using cannabis (0.16, 95% CI: 0.14, 0.19), using other drugs (0.17, 95% CI: 0.14, 0.21), and violence/harassment (0.16, 95% CI: 0.12, 0.2). Total discipline predicted lower levels of reported community support (-0.07, 95% CI: -0.1, -0.05), feeling safe in school (-0.12, 95% CI: -0.16, -0.09), and school support (-0.16, 95% CI: -0.19, -0.12). Associations were greater in magnitude for more severe out-of-school discipline. Findings were inconsistent for police-involved discipline. CONCLUSION: Exclusionary school discipline and school policing-core elements of the school-to-prison pipeline-are previously unidentified population predictors of adolescent substance use and developmental risk.

Experiences with the Philadelphia police assisted diversion program: A qualitative study.

BACKGROUND: The U.S. relies far too heavily on punitive criminal justice strategies to address problems that are better prevented and resolved through social and health services. The resulting harms are especially large and longstanding for people trapped in the failed War on Drugs. Philadelphia launched a Police Assisted Diversion (PAD) program to address the highest rates of poverty, incarceration, and fatal overdose among large cities in the U.S. PAD enables police officers to connect people with supportive services in many instances that would otherwise result in arrest or through outreach when no crime is suspected. METHODS: We conducted semi-structured interviews with 30 clients, 15 police officers, and 12 other personnel involved with the program. Data were gathered in 2019 and 2020 and analyzed using standard qualitative methods. RESULTS: PAD represents a new less-punitive model for responding to illegal purchasing of drugs, possession of drugs, prostitution, and retail theft in Philadelphia. Clients reported mostly positive experiences with the program, identifying the primary benefits as avoided arrest and relational support from affiliated service providers. Police officers expressed support for the program in principle but skepticism about its effects in practice, questioning the quality of available services. Program personnel and police officers described multi-sectoral collaboration as essential to addressing frequent and diverse logistical challenges, including overly restrictive eligibility criteria, mistrust between police and service providers, and coordination across different neighborhoods. Finally, all three groups suggested that people can only benefit from service linkages when they are ready to engage and that inadequate access to resources like housing limits program effectiveness. CONCLUSIONS: The PAD program is a promising public health intervention for diverting people away from punishment and towards services to address unmet social and health needs. But increasing investments in training and in other supportive services is essential to sustainable and transformational change.

Missed opportunities: Arrest and court touchpoints for individuals who fatally overdosed in Philadelphia in 2016.

BACKGROUND: Many studies document high risk of fatal overdose after incarceration. Few explore earlier touchpoints in criminal justice processes, like arrests and court hearings. Understanding these touchpoints is important for several reasons. Arrest and adjudicatory processes are harmful even when not resulting in incarceration. Arrests and criminal hearings also may reflect changes in overdose-related risk factors like transitions in employment and housing stability. Moreover, knowledge about these touchpoints contextualizes debate about the implementation of court-based programs like Drug Treatment Courts. This study described the incidence and accumulation of touchpoints for people who fatally overdosed in Philadelphia in 2016, and depicted how touchpoint incidence and characteristics interface with court-program eligibility. METHODS: Criminal court documents were obtained for all individuals who fatally overdosed in Philadelphia in 2016 from the Philadelphia Medical Examiner's Office. The characteristics of arrests and court hearings were abstracted to compile lifetime criminal histories. Latent class analysis was performed to identify whether these histories followed observably distinct patterns. RESULTS: In 2016, 907 people fatally overdosed in Philadelphia. Of these, 605 had at least one or more of 3,926 arrests and 3,822 hearings over their lifetime. There were 488 arrests and 533 hearings in the two years before death, with public disorder charges especially common closer to death. Less than 20% of these hearings resulted in custodial sentences. Of individuals with touchpoints, only nine participated in Drug Treatment Court, consistent with findings that most individuals were ineligible. Latent class analysis suggested five distinguishable patterns in age, timing, and characteristics of touchpoints. CONCLUSIONS: The type and frequency of touchpoints preceding fatal overdose reflect a period of complex vulnerability. Few individuals qualified for court-based programming, underscoring the limitations of supporting this population in specialized court settings. Reducing incidence and improving the health impact of criminal justice touchpoints remain important public health priorities.

Provider Experiences with Prison Care and Aftercare for Women with Co-occurring Mental Health and Substance Use Disorders: Treatment, Resource, and Systems Integration Challenges.

Incarcerated women with co-occurring mental health and substance use disorders (COD) face complex psychosocial challenges at community reentry. This study used qualitative methods to evaluate the perspectives of 14 prison and aftercare providers about service delivery challenges and treatment needs of reentering women with COD. Providers viewed the needs of women prisoners with COD as distinct from those of women with substance use alone and from men with COD. Providers described optimal aftercare for women with COD as including contact with the same provider before and after release, access to services within 24-72 hours after release, assistance with managing multiple social service agencies, assistance with relationship issues, and long-term follow-up. Providers also described larger service system and societal issues, including systems integration and ways in which a lack of prison and community aftercare resources impacted quality of care and reentry outcomes. Practice and policy implications are provided.

"I know if I drink I won't feel anything": substance use relapse among depressed women leaving prison.

PURPOSE: The purpose of this paper is to explore treatment needs and factors contributing to engagement in substance use and sobriety among women with co-occurring substance use and major depressive disorders (MDDs) as they return to the community from prison. DESIGN/METHODOLOGY/APPROACH: The paper used qualitative methods to evaluate the perspectives of 15 women with co-occurring substance use and MDDs on the circumstances surrounding their relapse and recovery episodes following release from a US prison. Women were recruited in prison; qualitative data were collected using semi-structured interviews conducted after prison release and were analyzed using grounded theory analysis. Survey data from 39 participants supplemented qualitative findings. FINDINGS: Results indicated that relationship, emotion, and mental health factors influenced women's first post-prison substance use. Women attributed episodes of recovery to sober and social support, treatment, and building on recovery work done in prison. However, they described a need for comprehensive pre-release planning and post-release treatment that would address mental health, family, and housing/employment and more actively assist them in overcoming barriers to care. PRACTICAL IMPLICATIONS: In-prison and aftercare treatment should help depressed, substance using women prisoners reduce or manage negative affect, improve relationships, and obtain active and comprehensive transitional support. ORIGINALITY/VALUE: Women with co-occurring mental health and substance use disorders are a high-risk population for negative post-release outcomes, but limited information exists regarding the processes by which they relapse or retain recovery after release from prison. Findings inform treatment and aftercare development efforts.