An Implementation Evaluation of the Comprehensive Addiction Recovery Act (CARA) Policy in New Mexico.

PURPOSE: The purpose of this field report is to describe an evaluation of the fidelity with which the comprehensive addiction and recovery act (CARA) policy has been implemented in New Mexico. DESCRIPTION: The CARA program in New Mexico focuses on providing nonpunitive supportive care for pregnant people affected by substance use and on coordinating services for parents, caregivers, and family members of newborns affected by substance exposure. The evaluation used information from program reports, a family follow-up survey, the plan of safe care database, and a data linkage between CARA participant records with Medicaid claims data. RESULTS: Follow-up survey data substantiated the program reports. Both sources showed that families were not engaged consistently in developing or receiving information about plans of safe care. The survey answers also indicated that the time-period immediately after the delivery of a baby is not the best time to communicate the contents of the plan of safe care to families. Additionally, the survey found that respondents believed that medical staff judged them for using substances during pregnancy. The Medicaid data linkage showed that 40.3% of families of infants exposed to substances in-utero did not receive a plan of safe care. Program reports revealed that limited resources existed for implementing CARA. CONCLUSION: Program funding, limited system capacity, lack of systematic screening for prenatal substance use, regional differences in access to care, and provider biases toward pregnant people using substances affected health-care workers' ability to identify at-risk families and develop plans of safe care. To support CARA implementation, healthcare systems must implement universal prenatal substance use screening, increase the level of anti-bias training pertaining to substance use, increase hospital supports, and improve data management systems.

What is already known on this subject? Stigma towards pregnant people for maternal substance use reduces access to prenatal care due to fear of involvement from child protective services. Punitive approaches to perinatal substance use result in lower healthcare utilization and opportunities to treat substance use disorder. What this study adds? This field report evaluates the implementation of a non-punitive state level policy meant to increase services for pregnant people using substances and reduce reports to child protective services for abuse neglect due to infants exposed to substances prenatally.

Gangs, violence, and fear: punitive Darwinism in El Salvador.

This article evaluates the factors impacting support for tough on crime policies in El Salvador. Examining theoretical and empirical scholarly work, we look at how fear, together with social and political contexts drive public appetite for punitive policies towards criminals. We show that President Nayib Bukele is responding to public opinion and has implemented tough on crime policies at the expense of human rights violations and democratic institutions. Society favors candidates who are the "toughest" against criminal actors. Political candidates from all sides of the ideological spectrum tap into the fear of the populace to win votes, leading to punitive Darwinism. We provide an empirical assessment of which theoretically relevant factors are statistically associated with punitivism in the Salvadoran context, using multiple regression analysis of high-quality public opinion survey data from LAPOP.

Exclusionary discipline practices and their relation to Chilean students' perception of school climate practices.

One of the challenges of school climate policies has been to promote dialogical conflict resolution by reducing punitive practices and encouraging student participation. However, exclusionary punitive practices are still being used, and in Chile, they are considered acceptable forms of conflict resolution. In this study, we analyzed the association between students' reports of punitive and democratic school climate in a sample of 2459 eighth graders (mean age = 13.56, SD = 0.84) from 128 Chilean schools. Multilevel analyses showed that a higher perception of punitive practices and higher academic performance were associated with a higher perception of an inclusive, democratic, and peaceful school climate. The perception of a higher school-level frequency of punishment was associated with a higher perception of an inclusive and democratic school climate. We discuss the implications of these findings for an authoritarian school culture.

Impact of stigmatizing language describing opioid-exposed mother infant dyads: A randomized case vignette study.

Background: Existing literature suggests that using stigmatizing language may promote negative attitudes and result in more punitive views toward individuals with addiction. It is unclear how the commonly used colloquial terms to describe opioid-exposed mother infant dyads impacts public opinion of pregnant women with opioid use disorder (OUD). We sought to examine the extent to which language such as "opioid addict" and "born addicted" influences the perception of pregnant women with OUD. Methods: We conducted a randomized case-based vignette study using a population-weighted sample of parents living in Tennessee, varying in the language used to describe an opioid-exposed mother infant dyad. Participant demographics, views on opioid prescribing, and opinions on criminal justice and child welfare responses following delivery were obtained. Ordinal logistic regression was used to examine the association between vignette type and punitive responses. Results: Eleven hundred participants completed the survey. Overall, 30.6% felt the mother should be arrested and 68.6% felt the mother should lose custody of her infant. There was insufficient evidence to suggest a difference in punitive response selection based on the vignette language (p = 0.27). In the adjusted model, the odds of answering a more punitive response among parents who received non-stigmatizing language was 0.8 (95% CI 0.59-1.08) compared to parents who received stigmatizing language in the vignette. Conclusions: Many parents hold punitive views toward mothers receiving OUD treatment that was not altered by using less value-laden language. Broader stigma-reduction interventions may be more effective.

On the origins of the concept of 'latent schizophrenia' in Russian psychiatry.

In the mid-twentieth century in the Soviet Union, latent schizophrenia became an important concept and a matter of research and also of punitive psychiatry. This article investigates precursor concepts in early Russian psychiatry of the nineteenth century, and examines whether - as claimed in recent literature - Russian and Soviet research on latent schizophrenia was mainly influenced by the work of Eugen Bleuler.

Toddlers' expectations of corporal third-party punishments against the non-defender puppet.

Recent research has demonstrated that toddlers expect individuals to approach and reward those who defend a victim from an aggressor rather than those who refuse to do so. This work focused on toddlers' expectations of corporal third-party punishments trought various actions, such as hitting with a stick or repelling someone who refused to defend a social partner following aggression. Using a violation of expectation paradigm (VoE), three experiments were carried out to investigate whether 21-month-olds expect others to apply different kinds of corporal punishments against the non-defender puppet (expected event) rather than the defender puppet (unexpected event), showing a bystander hitting with a stick (Experiment 1) or pushing strongly (Experiment 3) each of the two puppets. In both experiments, toddlers showed to be surprised whent the saw the bystander punish by hitting or pushing the defender puppet rather the non-defender puppet. In a control experiment displaying a non-social condition (Experiment 2), in which the victim puppets were replaced by two inert boxes, toddlers showed no expectation. These results uncovered that toddlers expect others to engage in different corporal punishments toward those who refuse to defend a social partner from an aggressor, by revealing that these expectations are not specific to a single type of punishment. The findings raise questions about the development of corporal third-party punishments, and have implications for the theory on ontogenetic processes underlying sociomoral development.

The impact of a brief RNR-based training on Turkish juvenile probation officers' punitive and rehabilitative attitudes and recidivism risk perceptions.

The present quasi-experimental study examined the impact of a brief training program based on the risk-need-responsivity (RNR) model on Turkish juvenile probation officers' (JPOs) punitive and rehabilitative attitudes toward justice-involved youth and recidivism risk perceptions. Fifty-nine JPOs were recruited through three probation offices in Istanbul, Turkey. Thirty-six JPOs, who received a 1-day training in the RNR model of offending behavior, were compared to JPOs in a wait-list control condition (n = 23). Participants in both conditions completed surveys at baseline and 1-week posttraining. Mixed-factorial analysis of variances revealed a significantly higher decrease in JPOs' punitive attitudes from pre- to posttest, in the training condition compared to the control group, with a medium effect size. Rehabilitative attitudes decreased in both conditions, while recidivism risk perceptions did not change from pre- to posttest in either condition. Future research could expand on these promising results using a more intensive training program and a randomized-controlled design in a larger sample of JPOs.

How discrimination and perspective-taking influence adolescents' attitudes about justice.

Little is known about factors influencing adolescents' justice attitudes. This online study investigates perspective-taking and experiences with discrimination for their associations with adolescents' beliefs about how justice is best served. Participants included 179 ethnically/racially diverse high school students (Mage = 16.67 years; SD = 1.02). Higher perspective-taking was associated with less punitive and more restorative attitudes. Youth reporting more personal and ethnic/racial discrimination experiences endorsed more restorative justice attitudes. Perspective-taking also moderated the associations between reports of family, personal, and religious discrimination and punitive justice attitudes: adolescents reporting higher discrimination showed a stronger inverse relationship between perspective-taking and punitive attitudes. Findings have implications for school and community programs aiming to implement restorative policies, and for adolescents' civic participation.

Reducing Stigma and Punitive Attitudes Toward Pedophiles Through Narrative Humanization.

Stigmatization and societal punitiveness about pedophilia have a range of potential consequences, such as the social isolation of people with sexual interest in children, and the formation of policies that are not consistent with empirical research findings. Previous research has shown that people with pedophilic sexual interests use societal thinking to self-stigmatize, which in turn may actually serve to increase their risk of committing a sexual offense. In this study, we compared two attitudinal interventions (first-person narrative vs. expert opinion) using a student sample ( N = 100). It was hypothesized that both interventions would lead to reductions in stigmatization and punitive attitudes about pedophiles on an explicit (self-report) level but that only the narrative intervention would lead to reductions of these constructs at the implicit level. Our findings supported both hypotheses. We further discuss the role of narrative humanization in this area and offer suggestions for further research based upon the theoretical and methodological implications of the findings.

Guilt, Disgust, and Not Just Right Experience Mediate the Effect of Demanding Parent Mode on Obsessive-Compulsive-Disorder-like Tendencies, and Punitive Parent Mode Moderates This Mediation.

The main objective of the present study was to examine, in a non-clinical population, the validity of a moderated mediation model for obsessive mental functioning. The research was conducted on a sample of 205 participants. Data were collected using the Psychiatric Screening and Diagnostic Questionnaire, Young's Modes Questionnaire-form SMI-2, Padua Inventory of Obsessive-Compulsive Symptoms, Fear of Guilt Scale in OCD, Disgust Propensity and Sensitivity Scale-Revised, and Not Just Right Experiences Questionnaire-Revised. The results revealed that there is a significant positive, indirect effect of the Demanding Parent mode on OCD-like tendencies, which is completely mediated by fear of guilt, tendency and sensitivity to disgust, and Not Just Right Experiences severity. The Punitive Parent mode moderates only the indirect effect of the Demanding Parent mode mediated by fear of guilt, not the indirect effect mediated by disgust tendency and sensitivity and Not Just Right Experiences severity. Also, the indirect effect of the Demanding Parent mode on obsessive tendencies mediated by fear of guilt is significant only at medium and high values of the Punitive Parent mode, not at low values of the moderator. Our results provide a novel direction targeting the direct therapeutic intervention on demanding and punitive internal dialogue, complementing the classical CBT intervention protocol.

Sequencing drinking events and use of punitive, nonpunitive, and positive parenting behaviors with ecological momentary assessment.

BACKGROUND: The relationship between alcohol use and parenting is primarily predicated on use of both past year drinking and parenting behaviors, making it difficult to develop prevention and intervention efforts that target alcohol-related maltreatment. Here, we assess the sequencing of parenting behaviors in relation to alcohol use (e.g., whether punitive parenting and alcohol use occur simultaneously). METHODS: Using Ecological Momentary Assessment, a convenience sample of parents was asked to take three brief surveys daily (at 10 a.m., 3 p.m., and 9 p.m.) for 14 days. If the parent was with the focal child, they were asked to identify whether they had used one of six randomly assigned parenting behaviors (punitive, nonpunitive, or positive). Alcohol use was queried at the 9 p.m. survey on days 7 and 14. Logistic multilevel models were used to analyze the data. FINDINGS: Parents reported less nonpunitive parenting during the time in which they reported drinking, and less positive parenting behaviors on the morning after the drinking occurred. CONCLUSIONS: Parents may be less attentive to children's behavior while drinking, or they may be less inclined to find that behavior needing correction. Drinking may reduce the likelihood of positive parenting the next day if parents are feeling hungover or have negative aftereffects from drinking. These parents may want to explicitly have another adult provide caregiving duties during the drinking event or plan drinking when it is less likely to cause the least amount of harm (e.g., when children are in bed).

History of abuse and adolescent hostile-helpless attachment: The mediating role of mother-adolescent punitive interactions.

BACKGROUND: Hostile-Helpless (HH) state of mind is a form of disorganised attachment that is strongly associated with prior experiences of abuse. However, how abuse experiences contribute toward HH states of mind in late adolescence is unknown. Punitive control in adolescent-mother dyads has been implicated in the development of HH states of mind and adolescent sex/gender may influence how punitive interactions contribute to HH mind states. OBJECTIVE: The present study aimed to explore how adolescent sex/gender and punitive control within adolescent-mother dyads are related to the links between HH states of mind and childhood abuse. PARTICIPANTS AND SETTING: A sample of 109 low-moderate income late adolescents (aged 18-23 years, 65 females, 44 males) and their mothers were assessed in a conflict-resolution paradigm. METHODS: Recordings of the interactions were coded using the Goal-Corrected Partnership in Adolescence Coding System for different aspects of attachment-based interactions including punitive control. Late-adolescent HH states of mind features were coded from Adult Attachment Interviews (AAI) and experiences of abuse were coded from adolescent self-reports and the AAI. RESULTS: Moderated mediation analysis revealed a significant indirect pathway from abuse to HH states of mind through punitive control in late adolescent females (B = 0.06, SEBoot = 0.04, 95 % CIBoot 0.01, 0.15), but not males (B = -0.02, SEBoot = 0.02, 95 % CIBoot - 0.07, 0.02). CONCLUSIONS: The results indicate that there are sex/gender-specific pathways to developing HH states of mind. Hostile behavior within mother-daughter dyads therefore may play an important role in linking abuse experiences and contradictory attachment representations in late adolescent females.

The place of punishment: Variation in the provision of inmate services staff across the punitive turn.

Despite the growing literature on the punitive turn, knowledge of how the experience of American imprisonment varied across time and place remain limited. This article begins to fill that gap, providing a more nuanced portrayal of rehabilitation during the punitive turn. PURPOSE: To examine how one aspect of the rehabilitative ideal in practice-the provision of staff dedicated to inmate services-varied across time and place over the past 30 years. METHODS: The article presents statistics on the inmate-to-staff ratios for inmate services staff (including teachers, counselors, doctors, etc.) between the years 1979 and 2005 for all 50 U.S. states. RESULTS: The analyses reveal that, while there was a substantial decline in the services staff ratio during the 1990s and 2000s, this shift across time paled in comparison to variation across place. Northeastern prison systems, for example, maintained higher inmate services staff ratios in 2005 than Southern states in any year. In addition, results suggest state variation is related to differences in prison crowding, inmates' racial composition, and political cultures. CONCLUSIONS: The findings suggest the punitive turn was more variegated and partial than is often assumed and highlight the importance of exploring state variation in penal practices.

Assessing the Association of Solitary Confinement Ban With Adolescent Self-Harm in New York City Jails.

This study sought to evaluate the association of a solitary confinement ban with self-harm among adolescents in New York City's jail system. Data were extracted from medical records on 5,038 adolescent incarcerations from October 1, 2013, through July 12, 2016, and compared incarcerations before the ban (February 20, 2015) with those after the ban. Of the 2,503 adolescent incarcerations pre-ban, there were 171 self-harm gestures among 106 incarcerations (4.2% of incarcerations). Post-ban, there were 2,100 adolescent incarcerations and 105 self-harm gestures among 71 incarcerations (3.4% of incarcerations; p < .01). The post-ban group experienced significantly lower self-harm risk compared with the pre-ban (Crude incident rate ratio, 1.35 vs. 1.81; p < .05). In adjusted analysis, the hazard of self-harm associated with solitary confinement exposure was 1.51 times that of incarcerations with no solitary exposure (p < .05) . This signifies negative health outcomes of adolescent solitary confinement and the need for policy change consideration.

Can retail investors induce corporate green innovation? -Evidence from Baidu Search Index.

China's rapid economic development has caused some environmental damage in recent years. The popularity of the Internet has enriched the ways for investors to obtain information, which would exert an impact on corporate environmental behavior. Focusing on micro-enterprise green innovation from the perspective of informal regulation, this paper investigates the impact of investor attention on corporate green innovation. This study takes Chinese A-share listed companies from 2011 to 2018 as samples, constructs panel fixed-effects models and adopts multiple linear, Logistic and Tobit regressions. This article finds that investor attention, measured by the web search index, can significantly improve corporate green innovation. The conclusion is still valid after a series of robust tests. Besides, mechanism tests reveal that investor attention can promote corporate green innovation by improving the implementation efficiency of punitive environmental regulation, the use efficiency of environmental subsidies, and by increasing the reputation cost of enterprises. In additional tests, this paper further clarifies that investors' attention to negative public opinion can play a better role in environmental governance, and reveals the reason why investors are motivated to improve corporate green innovation. This research puts forward a unique perspective, which extends the understanding of informal environmental regulation and enriches research on green innovation at the micro-enterprise level, promoting the cross research of finance and environmental protection.

Patient Safety Culture in Primary Healthcare Centers in the Eastern Province of Saudi Arabia.

PURPOSE: This study aimed to explore health-care workers' perceptions of patient safety culture (PSC) at primary health-care centers (PHCs) in the Eastern Province of Saudi Arabia and the factors that influence them. An additional aim was to identify the challenges of adopting PSCs in the PHCs of this region. METHODS: This is a cross-sectional study that adopted a PSC questionnaire from the Agency for Healthcare Research and Quality (AHRQ). The questionnaire was administered online and onsite targeted health-care workers at private, governmental, and quasi-governmental PHCs in the Eastern Province of Saudi Arabia, with 310 participants completing the survey. RESULTS: The overall positive response rate of participants to the survey areas was 43.5% which is lower than the average for the AHRQ data in general. Teamwork scored the highest positive response (68.8%) while Number of Events and non-punitive Response to Error scored the lowest at 10.6% and 30.7%, respectively. In addition, ANOVA and t-tests were used to determine the bivariate associations for the parametric variables. The study reveals statistically significant differences between all demographic variables and overall PSC score, except by age. CONCLUSION: The findings highlight a number of areas for improvement, particularly in relation to event reporting, non-punitive responses, and openness in communication. Consequently, establishing a safety culture in health-care organizations necessitates the elimination of three crucial elements regarding errors: blame, fear, and silence. Error reporting should not just be considered a means of learning from mistakes; it should also be considered the first step towards preventing injury and improving patient safety.

Is It Time for "Time-In"?: A Pilot Test of the Child-Rearing Technique.

Time-out, a mainstay of non-punitive discipline for over 60 years, has been criticized for isolating and distancing children from others. An alternative technique, one promoted by advocates of positive parenting practices, is labeled "time-in". This procedure is intended to help the child connect to the parent, communicate their feelings, and learn how to self-regulate. Although the technique has been advocated in the positive parenting literature since at least the 1990s, there are few empirical studies evaluating it. This pilot mixed-models study was designed as an initial test to determine whether mothers, following a brief training, would use the procedure over a two-week period, and how they would view it. Based on the daily reports as well as post-intervention interview of a small sample of mothers, the technique was evaluated as easy to use and effective. This study provides initial information about mothers' use of the technique and sets the stage for a comprehensive set of studies to rigorously test and evaluate the technique.

Patient Safety Culture in a Teaching Hospital in Eastern Province of Saudi Arabia: Assessment and Opportunities for Improvement.

PURPOSE: The objective of the present study is to explore the perceptions of patient safety culture (PSC) among King Fahd University Hospital's (KFUH) employees and to develop recommendations to overcome the factors that impede the integration of PSC in the study setting. METHODS: This is a cross-sectional study that assessed the level of PSC at KFUH. This study used the Hospital Survey on Patient Safety Culture tool from all KFUH healthcare workers (n=900) in 2018. FINDINGS: The response rate of the study was 67%. Findings show that KFUH excelled in three PSC composites: continuous organizational learning, feedback and communication about error, and frequency of events reported. In contrast, staffing, teamwork within units, and non-punitive response to error yielded low composite scores. ORIGINALITY/VALUE: The strength of the present study was the use of a valid questionnaire that has been used widely in the literature with a large sample size, which yielded valid results. It is, to our knowledge, the first research study that analyzes health workers' perceptions on patient safety culture in a teaching hospital in Eastern Province in KSA and compares it with Agency for Healthcare Research and Quality (AHRQ) and Saudi Hospital Survey on Patient Safety Culture (HSPSC). Results from the study highlight the need to employ an adequate number of workers, implement continuous patient safety training programs, and adopt safety programs and policies.

Punitive Social Policy and Vital Inequality.

Geographical inequalities in life and death are among the world's most pronounced in the United States. However, the driving forces behind this macroscopic variation in population health outcomes remain surprisingly understudied, both empirically and theoretically. The present article steps into this breach by assessing a number of theoretically informed hypotheses surrounding the underlying causes of such spatial heterogeneity. Above and beyond a range of usual suspects, such as poverty, unemployment, and ethno-racial disparities, we find that a hitherto neglected explanans is prison incarceration. In particular, through the use of previously unavailable county-level panel data and a compound instrumentation technique suited to isolating exogenous treatment variation, high imprisonment rates are shown to substantially increase the population-wide risk of premature death. Our findings contribute to the political economy of population health by relating the rise of the carceral state to the amplification of geographically anchored unequal life chances.

Estimating the impact on initiating medications for opioid use disorder of state policies expanding Medicaid and prohibiting substance use during pregnancy.

BACKGROUND: Medicaid expansion increased access to addiction treatment services for pregnant women. However, states' imposition of civil or criminal child abuse sanctions for drug use during pregnancy could inhibit access to treatment. We estimated the effects of Medicaid expansion on pregnant women's medications for opioid use disorder (MOUD) use, and its interaction with statutes that prohibit substance use during pregnancy. METHODS: Using the Treatment Episode Dataset for Discharge (2010-2018), we identified the initial treatment episode of pregnant women with opioid use disorder (OUD). We described changes in MOUD use and estimated adjusted difference-in-differences and event study models to evaluate differences in changes in MOUD between states that prohibit substance use during pregnancy and states that do not. FINDINGS: Among a total of 16,070 treatment episodes for pregnant women with OUD from 2010 to 2018, most (74%) were in states that expanded Medicaid. By one year post-expansion, the proportion of episodes receiving MOUD in states not prohibit substance use during pregnancy increased by 8.7% points (95% CI: 2.7, 14.7) from the pre-expansion period compared to a 5.6% point increase in states prohibiting substance use during pregnancy (95% CI: -3.3, 14.8). In adjusted event study analysis, the expansion was associated with an increase in MOUD use by 15.3% by year 2 in states not prohibiting versus 1.5% percentage points in states prohibiting substance use during pregnancy, respectively. CONCLUSIONS: State policies prohibiting substance use during pregnancy may limit the salutary effects of Medicaid expansion for pregnant women who could benefit from MOUD treatment.