Criminal Justice Clients Research Articles

Qualitative insights into mental health treatment through telemedicine during the COVID-19 crisis: a natural experiment in community mental health centers

BackgroundThe COVID-19 pandemic exacerbated existing mental health challenges and introduced new ones, particularly among vulnerable populations such as individuals within the criminal justice system, who disproportionately experienced employment, financial, and housing issues. As mandatory lockdowns and social distancing mandates were implemented, the United States saw unprecedented interruptions to treatment. Telemedicine emerged as a transformative tool in alleviating new and existing treatment barriers. Yet, limited empirical research has examined the impact and implications of telemedicine on mental health treatment in criminal justice populations.MethodsThe timing of this study’s data collection overlapped with the spread of COVID-19 in the United States and provided a unique opportunity to examine the impact of telemedicine as part of a natural experiment. Utilizing interviews with 61 community mental health center service providers, this study qualitatively examined service providers’ experiences in treating criminal justice-involved individuals with serious mental illness who were receiving mental health treatment through telemedicine.ResultsService providers expressed satisfaction with telemedicine in addressing client transportation and childcare barriers while increasing engagement. Service providers voiced new concerns regarding clients’ confidentiality, digital literacy, and limitations to gathering non-verbal client information during virtual treatment.ConclusionsMental health treatment offered through telemedicine mitigates barriers to treatment that disproportionately affect criminal justice clients. Despite its benefits, challenges like access to reliable internet and to internet-enabled devices, confidentiality concerns, and information gathering must be addressed to achieve optimal and equitable mental health treatment through telemedicine. The findings support the continued use of telemedicine in mental health treatment delivery for this population.

Risk factors for dropout from psychological substance use disorder treatment programs in criminal justice settings

BackgroundSubstance use disorders are highly prevalent in people within the criminal justice system. Psychological programs are the most common type of treatment available and have been shown to decrease recidivism, but dropping out of treatment is common. Risk factors associated with treatment dropout remain unclear in this setting, and whether the risk factors differ by treatment form (group-based vs. individual). MethodsOutcome (treatment dropout) was defined as not finishing the program due to client’s own wish, misbehavior, no-shows, or because program leader found client to be unsuitable. Predictors of treatment dropout included a comprehensive set of individual-level clinical, socioeconomic, and crime-related pre-treatment characteristics. Multivariable regression models were used to estimate the associations between predictors and dropout. FindingsThe study cohort included 5239 criminal justice clients who participated in a psychological treatment program (group-based or individual). Multivariable logistic regression models showed that female sex (OR=1.64, 95% CI 1.20–2.25), age (0.99, [0.97–1.00]), sentence length (0.98, [0.97–0.98]), higher education (0.54, [0.28–1.00]), number of violent offenses (1.03, [1.01–1.05]), and anxiety disorders (1.32, [1.01–1.72]) were associated with dropout from the individual treatment program. For the group-based program, age (OR=0.98, 95% CI 0.96–1.00), sentence length (OR=0.96, 95% CI 0.94–0.98), stimulant use disorder (OR=1.48, 95%, 1.00–2.19), and self-harm (OR 1.52, 95% CI 1.00–2.34) were associated with dropout. ConclusionsWe identified certain sociodemographic, crime-related, and clinical characteristics that were particularly important in predicting dropout from psychological treatment. Further, we find that there are similarities and differences in predictors of dropout from group-based and individual treatment forms.

Crime-Specific Recidivism in Criminal Justice Clients with Substance Use-A Cohort Study.

Criminal recidivism is a major global concern. There is a well-known association between substance use disorders and offending. Yet, little is known about crime-specific recidivism. The aim of this study was to investigate the relationship between specific substance use and crime-specific recidivism. The study is based on 4207 Swedish prison clients with substance use assessed with Addiction Severity Index interviews between 2001 and 2006. Clients were followed for an average of 2.7 years. Risk factors for criminal recidivism were assessed with the Cox regression analysis. Sixty-eight percent of the clients returned to the criminal justice system. Apart from well-known risk factors such as male gender and young age, amphetamine, injection drug use, prior prosecution for violent and property crime, as well as homelessness and psychiatric problems, were risk factors for criminal recidivism. Sedatives and cannabis were, in this setting, negative risk factors for general recidivism. Age, heroin and injection drug use elevated the risks of recidivism to property and drug crime. Alcohol was associated with violent recidivism. When analysing different categories of crime separately, risk factors differed substantially. This further highlights the need for crime-specific research. Identifying crime-specific risk factors should be an important part of improving rehabilitation into society after imprisonment and hopefully decrease recidivism.

Claim-Making Processes in Criminal Justice Social Work in India

Abstract This article discusses approaches and strategies in criminal justice social work that assert the claims of criminal justice clients over welfare and entitlements, in a context where their voices are compromised. It discusses claim-making and the dynamics underlying the process. The article reflects on the field experiences of a social work intervention project that the authors are associated with, that promotes legal rights and social re-entry of marginalised populations in criminal justice. The project’s work highlights the need for claim-making and participatory approaches towards development of policy and programmes in the neoliberal era.

Supersized Alcopop Consumption Associated With Homelessness and Gang Membership.

Supersized alcopops are single-serving, ready-to-drink beverages with very high alcohol content. Research suggests that consumption of these products is especially dangerous. The current study was one of the first to examine individual-level characteristics associated with recent consumption of supersized alcopops. Adults on probation (n=253; 70% male) in Baltimore City, MD, and Dallas, TX, who reported heavy drinking or any illicit drug use completed interviews. Psychosocial scales were drawn from the Criminal Justice Client Evaluation of Self and Treatment Intake. Bivariate analyses were conducted to examine characteristics associated with past 30-day consumption of supersized alcopops. Past 30-day consumption of supersized alcopops was significantly associated with higher scores for hostility and risk-taking, and lower scores on the self-esteem scale compared to nonconsumers. Recent consumption of supersized alcopops was also significantly associated with past 30-day homelessness and current gang affiliation. Among those who did not experience homelessness, 11% consumed supersized alcopops, compared to 30% of those who experienced homelessness. Further, 11% of those who were not gang-affiliated reported consuming a supersized alcopop within the past 30days, compared to 57% of those who were gang-affiliated. This study identifies disparate consumption of dangerous supersized alcopop products by vulnerable and at-risk groups. Better regulation of supersized alcopop marketing is needed to reduce alcohol consumption among high-risk groups, including people who are homeless and gang members, and display greater hostility and risk-taking traits. Previous research suggests that reducing the alcohol by volume and increasing the retail price of supersized alcopops would reduce some of the harms associated with consumption.

Gender, age, and ethnic differences in offending behavior among Hispanic/Latino criminal justice clients

Hispanic/Latinos are disproportionately represented in the criminal justice system. Using convenience sampling, the present study examined the lifetime and recent offending behavior of Hispanic/Latinos involved in community corrections in Miami, Florida. Descriptive statistics and multivariable logistic regression analyses were conducted. Participants were mostly male (59.7%), less than 40 years old (84.1%), and almost half were of Cuban descent (48.5%). Women were less likely to manufacture or sell drugs than men (AOR = .42, p < .03), and more likely to report recent prostitution (AOR = 7.34, p < .001) and stealing from houses or shops (AOR = 2.68, p < .01). Central Americans were less likely to report alcohol and drug related offenses than Cubans. Findings suggest that criminality among Hispanic/Latinos may vary by gender and by sub-groups. Prevention programs should be tailored accordingly.

Hepatitis C Virus and Hispanic Criminal Justice Clients: A Missed Opportunity.

To compare the willingness for HCV testing, HCV-knowledge, socio economic status, and HCV related risky behavior among male and female Latino offenders. Participants (n = 201) were recruited from the corrections system in Miami and interviewed. Backward stepwise logistic regression was conducted to compare gender-associated risk. Females (n = 81) were more likely to be engaged in risky sexual and drug behavior compared to males (n = 120). Overall, around 70% of the study population were interested to be tested for HCV if offered with no gender difference (OR 1.4, 95% CI 0.4-4.9). However, females were more likely to have lower income (OR 0.6, 95% CI 0.5-0.9) and engage in more HCV related risky sexual behaviors (OR 2.9, 95% CI 1.3-6.2), despite having better HCV related knowledge in five out of six items (OR 1.5-3.2), but had less crime activity (OR 0.6, 95% CI 0.5-0.8). HCV screening among Latino offenders would offer an efficient opportunity to reduce its burden as well as increase knowledge among vulnerable and high-risk population.

A Principled Approach to the Construction of Risk Assessment Categories: The Council of State Governments Justice Center Five-Level System.

Consistent risk category placement of criminal justice clients across instruments will improve the communication of risk. Efforts coordinated by the Council of State Governments (CSG) Justice Center led to the development of a principled (i.e., a system based on a given set of procedures) method of developing risk assessment levels. An established risk assessment instrument (Level of Service Inventory-Revised [LSI-R]) was used to assess the risk-level concordance of the CSG Justice Center Five-Level system. Specifically, concordance was assessed by matching the defining characteristics of the data set with its distribution qualities and by the level/category similarity between the observed reoffending base rate and the statistical probability of reoffending. Support for the CSG Justice Center Five-Level system was found through a probation data set (N = 24,936) having a greater proportion of offenders in the lower risk levels than a parole/community data set (N = 36,303). The statistical probabilities of reoffending in each CSG Justice Center system risk level had greater concordance to the observed Five-Level base rates than the base rates from the LSI-R original categories. The concordance evidence for the CSG Justice Center Five-Level system demonstrates the ability of this system to place clients in appropriate risk levels.

Both localized and systemic bacterial infections are predicted by injection drug use: A prospective follow-up study in Swedish criminal justice clients.

BackgroundBoth skin and soft tissue infections (SSTI) and systemic bacterial infections are common in people who inject drugs (PWID), but data on incidence and risk factors are lacking. We compared registered diagnoses for such infections in Swedish criminal justice clients with regard to injecting drug use.MethodsBaseline interview data from the Swedish Prison and Probation Service on drug use in PWID and non-PWID with problematic alcohol use were linked to follow-up data from national Swedish registers on hospital diagnoses and/or death. Associations between drug use and later diagnosis of SSTI and systemic bacterial infection (septicemia or bacterial infection of the heart, bone/joints or central nervous system) were analyzed by Cox regression.ResultsIncidence rates of SSTI was 28.3 per 1,000 person-years for PWID (n = 2,444) and 10.0 for non-PWID with problematic alcohol use (n = 735). Incidence rates of systemic bacterial infection was 9.1 per 1,000 person-years for PWID and 2.7 per 1,000 person-years for non-PWID. Injection drug use was associated with a significantly increased risk of bacterial infections, for main drugs heroin (SSTI: Hazard ratio [HR] 2.45; systemic infection: HR 2.75), amphetamine (SSTI: HR 1.60; systemic infection: HR 2.19), and polysubstance use (SSTI: HR 1.92; systemic infection: HR 2.01). In relation to injection use of amphetamine and polysubstance use, PWID mainly using heroin had higher risk of SSTI.ConclusionsInjection drug use predicted both SSTI and systemic bacterial infection, with a particularly high risk of SSTI in PWID mainly using heroin. The results imply the need for increased attention to bacterial infections among PWID, in terms of clinical management, prevention and research.

Substance Use, Criminal Recidivism, and Mortality in Criminal Justice Clients: A Comparison between Men and Women.

Background. This study aimed to map differences between male and female offenders with substance abuse, with respect to descriptive characteristics and risk factors for mortality and criminal recidivism. Methods. Criminal justice clients with substance abuse problems (n = 7085) were interviewed with the Addiction Severity Index. Mortality and data on return to criminal justice were retrieved from national registers. Results. Female offenders reported heavier substance use patterns, more psychiatric symptoms, and more often a partner with substance abuse, but had lower mortality (2% versus 4%) and criminal recidivism (62% versus 71%) during follow-up. Having a substance-abusing partner was associated with criminal recidivism among females. Conclusions. Female offenders with substance abuse differ from their male counterparts. Males and females had different risk factors for criminal recidivism.

The language of change among criminal justice clients: Counselor language, client language, and client substance use outcomes.

Counselor and client language have been identified as mechanisms of change in motivational interviewing (MI) counseling sessions. This study evaluated whether language patterns exhibited during MI sessions with substance users in the community would also be found during MI sessions with substance users in the criminal justice system. Forty audio recordings of MI sessions with substance-using probationers were coded and analyzed sequentially using the Motivational Interviewing Skills Code (MISC) 2.5. Analyses examined the relationship between counselor and client language, and the relationship between client language and client substance use after 2 months. Counselor MI inconsistent language was associated with decreased change talk (lnOR=-0.76, p<.05) though not with increased sustain talk. Both sustain talk (b=-4.591, t=-18.634 p<.001) and MI inconsistent language MIIN (b=-4.419, t=-19.886, p<.001) were positively associated with substance use at 2 months. Sustain talk early in the session (i.e., during deciles 1 and 2) was significantly greater among clients who reported using substances at 2 months, compared to clients who did not use substances. These findings are broadly consistent with previous literature documenting the association between counselor language, client language, and client outcome.

Offending Behavior, Drug Use, and Mental Health Among Foreign-Born versus U.S. Born Latino Criminal Justice Clients.

Little is known about the offending behavior and recidivism factors of Latinos by nativity (U.S. born, foreign-born). The present study focused on Latinos in community corrections (n = 201) in Miami, Florida, and examined differences in criminal activity, drug use, and mental health by nativity. Data were collected utilizing convenience sampling between June 2014 and December 2015. The research question was: what are the offending, drug use, and mental health histories of Latinos involved in community corrections? Participants were mostly male (n = 120; 59.7%), White (n = 105; 52.2%), and Cuban (n = 97; 48.3%). U.S. born community corrections clients (n = 141) were more likely to report more lifetime and recent criminal activity; and more likely to report lifetime and recent drug use behavior than foreign-born Latinos (n = 60). No differences were found in recent mental health. Correctional healthcare should tailor services such as substance abuse treatment differently toward U.S. born and foreign-born Latinos.

‘Love and trust, you can be blinded’: HIV risk within relationships among Latina women in Miami, Florida

ABSTRACTObjectives: Latina women are disproportionately affected by HIV in the US, and account for 30% of all HIV infections in Miami-Dade County, Florida. The main risk for Latina women is heterosexual contact. Little is known about the relational and cultural factors that may impact women’s HIV risk perception. This study aims to describe Latina women’s perception of their HIV risk within a relational, cultural, and linguistic context. Design: Eight focus groups of Latina women (n = 28), four English speaking groups and four Spanish speaking groups, were conducted between December 2013 and May 2014. Women were recruited from a diversion program for criminal justice clients and by word of mouth. Eligibility criteria included the following: self-identify as Hispanic/Latino, 18–49 years of age, and self-identify as heterosexual. A two-level open coding analytic approach was conducted to identify themes across groups. Results: Most participants were foreign-born (61%) and represented the following countries: Cuba (47%), Honduras (17.5%), Mexico (12%), as well as Nicaragua, Puerto Rico, Colombia, and Venezuela (15%). Participant ages ranged between 18 and 49, with a mean age of 32 years. Relationship factors were important in perceiving HIV risk including male infidelity, women’s trust in their male partners, relationship type, and getting caught up in the heat of the moment. For women in the English speaking groups, drug use and trading sex for drugs were also reasons cited for putting them at risk for HIV. English speaking women also reported that women should take more responsibility regarding condom use. Conclusion: Findings emphasize the importance of taking relational and cultural context into account when developing HIV prevention programs for Latina women. Interventions targeting English speaking Latina women should focus on women being more proactive in their sexual health; interventions focused on Spanish speaking women might target their prevention messages to either men or couples.

Developing a Culturally Appropriate HIV and Hepatitis C Prevention Intervention for Latino Criminal Justice Clients.

The population within the criminal justice system suffers from various health disparities including HIV and hepatitis C virus (HCV). African American and Latino offenders represent the majority of the offender population. Evidence-based interventions to prevent HIV and HCV among criminal justice clients are scant and usually do not take cultural differences into account. Toward this end, this study describes the process of culturally adapting an HIV/HCV prevention intervention for Latino criminal justice clients in Miami, Florida, by using the ecological validity model. Recommendations for culturally adapting an intervention for Latinos include an emphasis on language and integrating cultural themes such as familism and machismo.

Risk factors for unnatural death: Fatal accidental intoxication, undetermined intent and suicide: Register follow-up in a criminal justice population with substance use problems

BackgroundRisk factors for suicide and fatal accidental intoxication are extensively studied, while risk factors for intoxications/injuries of undetermined intent are less well known. The latter have shown an overlap with suicides, but also with fatal accidental intoxications. The objective was to analyze potential differences and similarities in the patterns of risk factors for accidental intoxications, injuries/intoxications with undetermined intent, and suicides, respectively. MethodsA follow-up register study was conducted, using data from ASI interviews with clients in the criminal justice system in Sweden (n=6744), followed in the National Causes of Death Register. A set of risk factors from the ASI interview were tested in bivariate analysis with the respective cause of death, yielding significant risk factors further analyzed in three Cox regression models. ResultsIn Cox regression analyses, death from fatal accidental intoxication was associated with male gender (HR 4.09), use of heroin (HR 2.86), and use of cannabis (HR 1.94), and death from intoxication/injury of undetermined intent was associated with use of heroin (HR 3.48), binge drinking of alcohol (HR 2.46) and previous psychiatric hospitalization (HR 2.41), while negatively associated with depression (HR 0.33). Death from suicide was associated with previous suicide attempts (HR 2.78) and use of sedatives (HR 2.17). ConclusionsIn this population of criminal justice clients with reported substance use problems, fatal injuries/intoxications with undetermined intent – like fatal accidental intoxications – appear to be associated with substance use variables, and cannot readily be assumed to represent the same background factors as suicide.

Client involvement in motivational interviewing sessions targeting substance abuse treatment in the criminal justice system

Background Motivational interviewing (MI) is a counseling technique used to elicit change by exploring an individual’ sd esire and commitment to making changes. In this study, probation clients are randomized to a two-session MI intervention occurring approximately 3–4 weeks apart. The first session primarily focuses on building motivation to change substance use, engage in treatment, and make other changes to improve probation outcomes; the second session focuses on goal setting and social support. Methods This paper examines responses from 96 clients who completed the first counselor-driven MI session. Researchers extracted client reasons associated with commitment to probation and treatment. Analyses matched the clients’ responses to the MI session with quantitative data on motivation to change, demographics, and criminal history obtained during the baseline assessment. Results Clients generally reported higher levels of treatment motivation during the MI session as compared to the scales from the CJ Client Evaluation of Self and Treatment (CEST). Results from the CEST indicated that the majority of the sample (79.2%) had low/moderate levels of motivation to seek help and recognize that they have a problem (82.3%). However, on a scale of 1–10, clients reported high commitment to complete probation (M = 9.67) and treatment/decreasing use (M = 8.30). Individuals under 36 years old who scored low/moderate on a criminal justice (CJ) risk tool, and males indicating that they did not want to go to jail reported higher commitment ratings. During the MI session, the primary reasons for increased motivation were family, tired of being in the CJ system, not wanting to go back to jail, and tired of using. For female probationers, family was the most frequently stated reason (28.6%) for being committed to finishing probation. Employment was the primary reason given for wanting to change substance use behavior, particularly among probationers under 36 years old. Older individuals were more likely to be tired of using drugs. During the MI session, clients’ goals for the next 30 days mostly dealt with probation issues like attending the first probation appointment (53.1%). Treatment-related goals (e.g., making a treatment provider appointment (26%) were less frequent. Conclusion

Developing an index to measure the voluntariness of consent to research.

The goals of the current study were to expand the content domain and further validate the Coercion Assessment Scale (CAS), a measure of perceived coercion for criminally involved substance abusers being recruited into research. Unlike the few existing measures of this construct, the CAS identifies specific external sources of pressure that may influence one's decision to participate. In Phase 1, we conducted focus groups with criminal justice clients and stakeholders to expand the instrument by identifying additional sources of pressure. In Phase 2, we evaluated the expanded measure (i.e., endorsement rates, reliability, validity) in an ongoing research trial. Results identified new sources of pressure and provided evidence supporting the CAS's utility and reliability over time as well as convergent and discriminative validity.

Social Workers’ Perspectives on Effective Practice in Criminal Justice Settings

Social workers practicing within the field of criminal justice face significant challenges. Through individual interviews, 17 experienced social workers from diverse criminal justice settings share their perspectives about the attributes needed for effective social work practice. Participants describe how they define success in their work and what it takes to be successful. They highlight specific ways of behaving within criminal justice settings, relationship qualities for working with criminal justice clients, and personal traits believed to be critical to effective practice. The participants also reflect on the value of their education and offer a suggestion for prospective criminal justice social workers.

Suicide in Prisoners: An Italian Contribution

It is well-known that suicidal behavior is very common among criminal justice clients, both among those serv- ing community sentences and among prison inmates. Suicide rates among prisoners are considerably higher than in the general population. There is great concern over high rates of suicide and suicidal behavior in prisons, with suicide preven- tion becoming a major challenge for penal institutions in many countries. In particular, Italian prisons are facing an impor- tant crisis. The aim of the present descriptive review is to investigate suicide in prisons, with particular attention to the Italian situation. To date, there are no comprehensive data on this phenomenon for reasons that are critically discussed in this paper. First, we focus on epidemiology, and try to summarize existing heterogeneous data. Demographic, criminologi- cal and clinical risk factors associated with suicide in prisoners are then examined. Understanding the process by which certain prisoners, under specific circumstances, contemplate, plan and decide to end their lives is critical to suicidal pre- vention, as discussed in the third part of the review. Finally, we suggest possible future investigations to improve detection of specific risk factors and we discuss the challenges to be faced in order to decrease suicide rate among prisoners.

All-cause mortality in criminal justice clients with substance use problems—A prospective follow-up study

BackgroundMortality in previously incarcerated individuals is known to be elevated, with high proportions of drug-related deaths. However, there is less documentation of whether specific substance use patterns and other clinical characteristics predict increased mortality in the group. MethodsThis is a follow-up study of mortality and causes of death in ex-prisoners with substance use problems prior to incarceration (N=4081), who were followed during an average of 3.6 years from release from prison until death or until data were censored. Baseline predictors of mortality, derived from interviews with Addiction Severity Index (ASI) in prison, were studied in a Cox regression analysis. ResultsDuring follow-up, 166 subjects (4.1%) died. Standardized mortality ratios were 7.0 (3.6–12.2) for females and 7.7 (5.6–9.0) for males. In 84% of cases, deaths were unnatural or due to substance-related disease. Most common causes of death were accidental poisoning (27%), transport accidents (13%), poisoning/injury with undetermined intent (12%), and suicide (10%). Death was positively predicted by heroin use, overdose, and age, and negatively predicted by a history of depression. ConclusionsA vast majority of deaths after release from prison in individuals with substance use are due to violent or substance-related causes. Significant predictors identified were mainly related to patterns of drug use, and need to be addressed upon incarceration as risk factors of death. The findings have implications for referral and treatment upon release from prison.