Perceptions of Community Corrections and Treatment Experience: A Qualitative Study Among People With Incarceration Histories Receiving Outpatient Methadone Treatment.

BACKGROUND: Community correctional experiences among individuals receiving methadone treatment (MT) for opioid use disorder (OUD) are poorly understood. We qualitatively investigated perceptions of community corrections and treatment experiences among individuals with criminal-legal system experience currently receiving outpatient MT. METHODS: From January to December 2017, we recruited 42 individuals with history of criminal-legal system involvement enrolled in outpatient MT at a low-barrier nonprofit organization operating multiple clinics in Connecticut. An experienced qualitative research team conducted one-to-one, in-person, semistructured interviews about incarceration and treatment experiences with individuals receiving MT. Participants completed a demographics survey. The interviews were audiorecorded, transcribed, de-identified, and independently coded using NVivo. RESULTS: Participants described the community corrections system as restrictive and abstinence-focused. Most participants described positive perceptions of and experiences with community corrections officers (CCOs), yet described negative perceptions of and experiences with the community corrections system overall. Participants perceived CCOs to have limited knowledge of OUD and MT. Participants described a range of CCO judgment toward their OUD, with some appearing understanding and nonjudgmental while others were perceived to have stigma and prejudice. Few participants noted assistance from CCOs with seeking MT or community-based substance use disorder care. Some participants desired improved treatment facilitation, but viewed forced or coercive treatment negatively. CONCLUSION: To our knowledge, this is the first qualitative study to examine community corrections experience among people receiving outpatient medication for OUD. While individuals receiving MT have negative experiences with the community corrections system, they perceive individual CCOs positively. Interventions addressing gaps in CCOs knowledge of OUD and MT are needed to optimize support for individuals on probation or parole with OUD. Provision of OUD treatment facilitation appears desirable to some individuals in community supervision.

People in community corrections are a population with unmet need for viral hepatitis care.

To reach World Health Organization elimination targets for hepatitis C, different strategies are needed to reach people who have not yet been diagnosed and treated. In the context of declining treatment initiation rates, innovation in service design and delivery is necessary: testing and treatment needs to be offered to people in non-traditional settings. The community corrections (probation and parole) population is larger than the prison population, which has high prevalence of hepatitis C and-in some countries-established diagnosis and treatment programs. In this Viewpoint we identify a gap in hepatitis C care for people under community correctional supervision, a group who have either never been imprisoned or need continuity of healthcare provided in prison. We propose that offering hepatitis C screening and treatment would benefit this population, and accelerate progress to hepatitis C elimination.

Studying Parole Revocation Practices: Accounting for Dependency Between Competing Events.

When individuals are released from prison, they typically enter a period of post confinement community supervision. While under community supervision, their behaviors are subject to special conditions requiring them to report to supervisors and prohibiting certain behaviors such as drug and alcohol use. Many supervisees are returned to prison because they violate those special conditions, or because they commit minor crimes that would not result in prison were they not being supervised. But others are returned to prison for serious new crimes. We distinguish the two as nuisance behaviors (the former) and pernicious behaviors (the latter). Our research applies competing events survival analysis to distinguish a structural model that accounts for nuisance behaviors from a structural model that accounts for pernicious behaviors. We demonstrate that returning offenders to prison for technical violations and minor crimes may reduce the incidence of major crimes because the occurrence of nuisance behaviors and pernicious behaviors are highly correlated. Our findings support the theory that nuisance behaviors signal the likelihood of pernicious behaviors.

Association between willingness to use an overdose prevention center and probation or parole status among people who use drugs in Rhode Island.

BACKGROUND: Overdose prevention centers (OPCs) are being implemented in the United States as a strategy to reduce drug-related mortality and morbidity. Previous studies have suggested that people who use drugs (PWUD) with a history of criminal legal system (CLS) involvement (e.g. current probation/parole) are at greater risk of overdose but may also encounter significant barriers to OPC use. The objective of this study was to explore the association between willingness to use an OPC and probation/parole status in a sample of PWUD in Rhode Island. METHODS: This study utilized data from the Rhode Island Prescription and Illicit Drug Study, which enrolled adult PWUD from August 2020 to February 2023. We used Pearson's chi-square and Wilcoxon rank-sum tests to assess bivariate associations between willingness to use an OPC and probation/parole status (current/previous/never), as well as other sociodemographic and behavioral characteristics. In multivariable Poisson analyses, we examined the association between willingness to use an OPC and probation/parole status, adjusting for key sociodemographic and behavioral characteristics. RESULTS: Among 482 study participants, 67% were male, 56% identified as white, 20% identified as Hispanic/Latine, and the median age was 43 (IQR 35-53). Nearly a quarter (24%) had never been on probation/parole, 44% were not currently on probation/parole but had a lifetime history of probation and parole, and 32% were currently on probation/parole. Most participants (71%) reported willingness to use an OPC, and in both bivariate and multivariable analyses, willingness to use an OPC did not vary by probation/parole status. Crack cocaine use and lifetime non-fatal overdose were associated with greater willingness to use an OPC (all p < 0.05). CONCLUSIONS: These data demonstrate high willingness to use OPC among PWUD in Rhode Island regardless of CLS-involvement. As OPCs begin to be implemented in Rhode Island, it will be imperative to engage people with CLS-involvement and to ensure access to the OPC and protection against re-incarceration due to potential barriers, such as police surveillance of OPCs.

Opioid Misuse and Associated Health Risks among Adults on Probation and Parole: Prevalence and Correlates 2015-2020.

BACKGROUND: As state legislatures work to reduce prison populations and increase the use of community-based alternatives, limited knowledge exists about the service needs of those under criminal justice supervision in the community. Preliminary research indicates unusually high rates of disease, disability, and death. Health risks for this population include opioid misuse, a form of substance misuse that has reached epidemic proportions in the U.S. Evidence indicates this may be one of multiple epidemics this population experiences, complicating intervention. METHODS: Our study included 5154 individuals on probation or parole. Using 2015-2020 data from the National Survey of Drug Use and Health (NSDUH), we conducted a series of logistic regressions examining associations between opioid misuse and a range of health risks, controlling for sociodemographic variables and survey year. RESULTS: Approximately 17% of those on probation or parole indicated past-year opioid misuse, a rate 4 times higher than in the general population. Compared to those on probation and parole who did not misuse opioids, it was associated with higher odds of other health risk behaviors and mental health problems. For example, the odds of marijuana and cocaine use were 4-6 times higher and the odds of substance use disorder were 10 times higher. Similarly, the odds of experiencing major depressive episodes and serious psychological distress were 2-3 times higher. CONCLUSIONS: Our findings reveal a markedly high risk for opioid misuse within this population along with associated risks for behavioral and mental health problems. The complex treatment needs of this population require greater policy attention and further research.

[Anorexia nervosa and the perinatal period]. / Anorexie mentale et période périnatale.

As a complex pathology, anorexia nervosa interacts with the psychological challenges of pregnancy, and raises questions about how to support the women concerned. As part of a multidisciplinary approach, support groups are particularly important, offering both individual and social support. Child-parent drop-in centers can also provide a supportive space for the psychological work of parenting.

Are Supervision Violations Filling Prisons? The Role of Probation, Parole, and New Offenses in Driving Mass Incarceration.

Advocates for reform have highlighted violations of probation and parole conditions as a key driver of mass incarceration. As a 2019 Council of State Governments report declared, supervision violations are "filling prisons and burdening budgets." Yet few scholarly accounts estimate the precise role of technical violations in fueling prison populations during the prison boom. Using national surveys of state prison populations from 1979 to 2016, the authors document that most incarcerated persons are behind bars for new sentences. On average, just one in eight people in state prisons on any given day has been locked up for a technical violation of community supervision alone. Thus, strategies to substantially reduce prison populations must look to new criminal offenses and sentence length.

[Functional neurological disorders: A clinical anthology]. / Troubles neurologiques fonctionnels : une anthologie clinique.

Functional neurological disorders have a broad phenotypic spectrum and include different clinical syndromes, which are sometimes associated to each other or appear consecutively over the course of the disease. This clinical anthology provides details on the specific and sensitive positive signs that are to be sought in the context of a suspected functional neurological disorder. Beside these positive elements leading to the diagnosis of functional neurological disorder, we should keep in mind the possibility of an associated organic disorder as the combination of both organic and functional disorders is a relatively frequent situation in clinical practice. Here we describe the clinical characteristics of different functional neurological syndromes: motor deficits, abnormal hyperkinetic and hypokinetic movements, voice or speech disorders, sensory disorders, and functional dissociative seizures. The clinical examination and the identification of positive signs play a critical role in the diagnosis of functional neurological disorder. Knowledge of the specific signs associated with each phenotype render possible to make an early diagnosis. For that matter, it contributes to the improvement of patient care management. It allows to a better engagement in an appropriate care pathway, which influence their prognosis. Highlighting and discussing positive signs with patients can also be an interesting step in the process of explaining the disease and its management.

The Case for Voluntary-Assisted Dying in Prisoners Serving Sentences of Life without Parole.

Legislation supporting voluntary-assisted dying (VAD) is becoming more common globally, where it is used to promote an individual's autonomy in settings where they choose to alleviate their suffering by ending their life. This article examines and advocates for access to VAD in a new group - prisoners serving sentences of life imprisonment without parole. It addresses several morally important issues, and offers an ethical framework based on comparison to VAD in the setting of the terminally ill.

The effects of emotion and juvenile diagnoses on parole release decisions: An experimental approach.

Parole boards are often required to make many release recommendations after reviewing a substantial amount of information in a short timeframe. While making release decisions, parole board members might be motivated to sacrifice accuracy and, instead, use heuristics, such as their emotions. Emotions might increase the reliance on risk or threat related information, such as an inmate's mental illness status. The current study applies the appraisal tendency framework of emotion to assess the impact of emotion on parole decisions involving juvenile mental health diagnoses. Using a 3(emotion: anger, compassion, and control) x 4(mental illness: conduct disorder, oppositional defiant disorder, depression, and control) factorial design, this study examined the extent to which mock parole board members' emotions impacted evaluations of inmates with juvenile mental illness diagnoses and subsequent release decisions. Results indicated that there was no effect of emotion on parole decisions. However, the inmates' mental illnesses did play a role in parole release decisions. Specifically, parole candidates with depression were released on parole at higher rates compared to conduct disorder, oppositional defiant disorder, and the control condition. Policy implications are discussed.

Factors to Reduce Drug-Related Recidivism Among Paroled Methamphetamine Users in Japan: 10-Year Data Analysis.

This study explored factors to reduce drug-related recidivism among paroled methamphetamine users in Japan, especially the significance of continuing care and motivation, internationally shown as positively related to better treatment outcomes. Cox proportional hazards regression analysis was performed on 10-year drug-related recidivism data from 4,084 methamphetamine users paroled in 2007 who received a mandatory educational program conducted by professional and volunteer probation officers. Independent variables included participant characteristics, an index of motivation, and the length of parole as a substitute for the duration of continuing care with consideration of the Japanese legal system structures and socio-cultural context. Older age, lower number of previous prison sentences, shorter imprisonment, longer parole, and index of higher motivation were significantly and negatively associated with drug-related recidivism. The results indicate the benefit of continuing care and motivation on treatment outcomes, regardless of the differences in socio-cultural context and criminal justice system.

Towards more accurate classification of risk of arrest among offenders on community supervision: An application of machine learning versus logistic regression.

BACKGROUND: Although there is general consensus about the behavioural, clinical and sociodemographic variables that are risk factors for reoffending, optimal statistical modelling of these variables is less clear. Machine learning techniques offer an approach that may provide greater accuracy than traditional methods. AIM: To compare the performance of advanced machine learning techniques (classification trees and random forests) to logistic regression in classifying correlates of rearrest among adult probationers and parolees in the United States. METHOD: Data were from the subgroup of people on probation or parole who had taken part in the National Survey on Drug Use and Health for the years 2015-2019. We compared the performance of logistic regression, classification trees and random forests, using receiver operating characteristic curves, to examine the correlates of arrest within the past 12 months. RESULTS: We found that machine learning techniques, specifically random forests, possessed significantly greater accuracy than logistic regression in classifying correlates of arrest. CONCLUSIONS: Our findings suggest the potential for enhanced risk classification. The next step would be to develop applications for criminal justice and clinical practice to inform better support and management strategies for former offenders in the community.

[The adventure of speech]. / L'aventure de la parole.

The step of going to a therapist is the fruit of a contingency of life, a painful reality, sometimes hardly noticeable and which becomes repetitive or unbearable. The therapist takes support on this adventure which begins in order to reveal the object which is nestled in the patient's speech. To orientate this work, the transference, the symptom and the part of jouissance are crossed. The adventure of speech thus takes the risk of going towards the intimate, present in what makes suffering. A psychoanalytical point of view is precious to enlighten the stakes of the relational field.

Residential Instability and Suicidal Ideation Among Persons on Parole.

Parolees experience numerous barriers that may impact successful reintegration into society. Residential instability may further add to these obstacles, as there may be limited opportunities for housing given their criminal history. The present study aimed to examine the impact of residential instability on suicidal ideation among parolees. Results indicated that residentially stable and unstable individuals had similar risk factors which were significantly associated with suicidality, such as age and having perceived unmet mental health needs. Other risk factors differed among the two groups, highlighting the importance of treatment and preparation for re-entry into society while in the prison setting.

Collateral consequences of COVID-19 for people on probation and parole.

BACKGROUND: While the severe detrimental impact of COVID-19 on incarcerated people is well known, little is known about the experience of COVID-19 on those on community supervision. Our objective was to better understand the experience of the COVID-19 pandemic and its collateral consequences for those on community supervision (e.g., probation, parole). Beginning in December 2020, we conducted 185 phone surveys about COVID-19 with participants in The Southern Pre-Exposure Prophylaxis (PrEP) Study across its three sites - Florida, Kentucky, and North Carolina. We conducted rapid assessment interviews with both closed- and open-ended questions. We calculated descriptive statistics for close-ended questions and conducted a content analysis for open-ended questions. RESULTS: The COVID-19 pandemic affected those on community supervision through their experiences in the community and while incarcerated with over one-quarter of participants being reincarcerated during this time. In addition to many (128/185) experiencing COVID-19 symptoms, about half (85/185) of participants reported a diagnosis in their network with 16 of those participants losing loved ones to the pandemic. Participants experienced disruptions to their social network, healthcare, and livelihoods. Though many maintained their support systems, others felt isolated and depressed. Experiences during COVID-19 exacerbated difficulties already faced by those with criminal involvement. CONCLUSIONS: The public health community must recognize those experiencing probation and parole, not only those housed in carceral facilities, as disproportionately impacted by the COVID-19 pandemic. We must tailor programs and services to meet their needs.

[When the body keeps the imprint of the break-in and the memory of the intrusion]. / Quand le corps garde l'empreinte de l'effraction et la mémoire de l'intrusion.

Not enough space is given to the voice of children and adolescents on the crucial subject of sexual violence. Marie Rose Moro, a child psychiatrist and specialist in cross-cultural issues, spoke on this topic in December 2021 at the symposium Repenser la place du corps en psychiatrie, de l'enfance à l'âge adulte. On this occasion, she addressed the way in which the body retains the imprint of the intrusion and the memory of the intrusion in the aftermath of sexual abuse.

Addressing the challenges of remorse in the criminal justice system.

Remorse in offenders appears in a number of criminal justice domains. It is a mitigating factor in sentencing, influences parole decision making, may be influential in offender rehabilitation, and may be valued in forensic mental health. However, evaluation of remorse presents challenges in relation to evidence for remorse and expectations about its performance. Nevertheless, remorse is embedded deeply in criminal justice. The consideration of remorse in relation to emotions of shame, guilt and regret may offer an approach for evaluating remorse in sentencing and for addressing remorse in offender rehabilitation. This approach to understanding and working with remorse requires further elaboration, development and testing.

Parole Work in Canada: Tensions in Supervising People Convicted of Sex Crimes.

Internationally, parole work is loaded with tensions, particularly when supervising a people convicted of sex crimes (PCSCs) who, due to their criminal history, are stigmatized and occupy the lowest rungs of the status hierarchy in prison and society more broadly. Drawing on analyses of interview data from federal parole officers (n = 150) employed by Correctional Service Canada, we interpret their perceptions and feelings about overseeing re-entry preparations and processes for the PCSCs on their caseloads. We unpack the "tensions" imbued in parole officers' internal reflections and negotiation of complexities in their efforts toward supporting client's rehabilitation efforts, desistance from crime while negotiating external factors (e.g., the lack of available programming), and being responsible for supervising PCSCs. We highlight facets of occupational stress parole officers experience, finding PCSCs may be more compliant when under supervision but may also require more of a parole officer's resources, including time and energy. We put forth recommendations for greater empirical nuance concerning parole officer work and their occupational experiences and beliefs about PCSC, particularly as related to parole officer health.

General Criminal Dynamic Risk and Strength Factors Predict Short-Term General Recidivism Outcomes Among People Convicted of Sexual Crime During Community Supervision.

There are clinical practice and operational reasons why it may be appropriate to primarily focus on general risk factors when supervising people convicted of sexual crime in the community. General risk domains may be particularly relevant when supervision officers engage in frequent reassessment of acute dynamic risk factors. We tested the ability of a case management tool, the Dynamic Risk Assessment for Offender Re-entry, to discriminate community based, short-term general (all outcome) recidivism versus nonrecidivism among people convicted of sexual crime (n = 562). We tested the predictive discrimination validity of each DRAOR item and then subscale scores in univariate and multivariate models (also controlling for general static risk). DRAOR scores were associated with general recidivism outcomes and effect sizes were generally similar or stronger compared to models with people convicted of nonsexual crime (n = 2854). DRAOR Acute scores were consistently and incrementally related to general recidivism outcomes beyond other scores. In practice, case managers should remain aware that people convicted of sexual crime are at risk for nonsexual recidivism outcomes and assess problematic functioning broadly alongside problems in sexual domains. Clinically, interconnection among domains potentially provides multiple avenues for effective intervention.