Prison Research Articles

Barriers to and Facilitators of Opioid Substitution Therapy in Penal Institutions: A Qualitative Study from Baden-Wuerttemberg, Germany

BACKGROUND: Opioid use is prevalent throughout prison populations worldwide. To date, opioid substitution treatment (OST) is considered as one of the most effective treatments for reducing drug-related harm associated with opioid dependence. Yet, large gaps prevail in the access and availability of OST in detention facilities in Germany. We investigated the views and attitudes of health professionals working in prisons in the federal state of Baden-Wuerttemberg towards OST and identified barriers and facilitators to the implementation of prison-based OST.METHODS: We conducted semi-structured expert interviews with nine physicians and one psychologist working in prisons in Baden-Wuerttemberg. The data was analyzed in MAXQDA using a qualitative content analysis approach. RESULTS: A majority of study participants (90%) held positive attitudes towards OST. Our findings suggest that concerns about OST medication diversion and the co-consumption of illegal drugs, insufficient staff capacity, and difficulties in ensuring continuity of care post-release posed barriers to prison-based OST. Additionally, the prison setting, an adequate personnel infrastructure, and the availability of technical equipment were perceived as facilitating the implementation of OST. The participants highlighted the need for an increase in medical personnel capacities and for improved transition management between intra- and extramural treatment settings. CONCLUSIONS: To improve drug using prisoners’ health, intramural OST needs to be adapted more to the particularities of­­ the prison setting such as offering less-divertible medication options and ensuring continuity of care after imprisonment. Research is needed on the acceptance of new OST medications among incarcerated populations and actionable treatment approaches.

Living conditions in Italian administrative detention centres for migrants: a scoping review

Abstract Since 2011, Italy has experienced a growing flow of migrants, despite the implementation of restrictive and detention-oriented procedures. Detention facilities for migrants must provide health protection and general assistance to the person. Considering the critical state of the centres reported by various sources, this study gives an overview of the conditions in Italian detention facilities for migrants from a public health perspective. A scoping search of the peer-reviewed and grey literature was performed to investigate the public health standards currently in force in Italian detention facilities for migrants and refugees (Hotspot and CPR-Pre-removal Detention Centres). Articles published from 2009 to 2021 in English and Italian were included and qualitatively described in five categories: provision of healthcare, living conditions, protection of vulnerable detainees, access to legal advice, and the Covid-19 pandemic. 11 peer-reviewed studies and 24 grey documents were included. Guidelines on screening procedures for infectious diseases or vaccines appeared to be hastily followed; chronic and mental diseases were not appropriately addressed. The facilities were described as run-down, with scarce and poor-quality meals, and lacking of educational activities. A lack of protection for vulnerable categories was reported, including unaccompanied minors. The Covid-19 pandemic further exacerbated pre-existing issues, highlighting systemic weaknesses in preparedness and response. Life conditions within the centres for migrants in Italy fall significantly short of acceptable standards. The main problems are the unavailability of cultural mediation services and the insufficient protection of mental health. The overall conditions appeared to be not dignifying and violations of the law are, if not frequent, present and well recognised. Urgent reforms are warranted to address these shortcomings and ensure the humane treatment and protection of migrants within these facilities. Key messages • Italy is responding to the recent inflow of migrants with policies oriented to detention and repatriation. To this, it established de-facto detention centres for migrants, namely Hotspot and CPRs. • The public health standards of migrants’ repatriation centres are poorly followed and life inside the centres appears misereble.

Mental Health Service Referral and Treatment Following Screening and Assessment in Juvenile Detention.

Numerous recommendations have been made to address the high rates of mental health disorders among justice-involved youth. Few data are available on the use, quality, appropriateness, or availability of services to address these needs. This study examined the relationship between trauma-informed mental health screening, other referral pathways for diagnostic evaluation, subsequent DSM-5 diagnoses, and treatments for evaluated youth. Eligible participants were all youth admitted to New York City secure juvenile detention facilities from September 17, 2015 to October 30, 2016 who remained in the facility for at least five days (N = 786). Of those, 581 (73.9%) were voluntarily screened and 309 (53.2%) later received a diagnostic evaluation. Youth who screened positive for depression, posttraumatic stress disorder, and problematic substance use were more likely to be evaluated. Treatment received was related to diagnosis rather than reason for referral. For youth who were referred for behavioral or emotional concerns, 99.1 percent (114 of 115) of those diagnosed with a neurodevelopmental disorder had attention-deficit/hyperactivity disorder (ADHD). These data are among the first to describe DSM-5 diagnoses and treatment among youth detainees. They highlight the prevalence of ADHD in detained youth and argue for the coordination of universal trauma-informed mental health screening and a structured referral system for this population.

Primary care need and engagement by people with criminal legal involvement: Descriptive and associational analysis using retrospective data on the entire population ever detained in one southeastern U.S. county jail 2014-2020.

More than 7 million people are released each year from U.S. jails or prisons, many with chronic diseases that would benefit from primary care in their returning communities. The objective of this study was to provide an in-depth, payer-agnostic description and associational analysis of primary care need and utilization by all individuals ever detained in one county detention facility over a 7-year period. Detention records 2014-2020 were merged with data from an electronic health record with excellent coverage of local primary care, emergency, and hospital services. We found low primary care participation for the group as a whole, with under three quarters of those with serious chronic diseases ever seeing a primary care provider over a 7-year period and less than half ever having a year with more than one visit. Multivariable regression models estimated associations between individual characteristics (demographic, detention-related, and clinical) and ever having access to primary care (logistic) and the number of primary care visits (zero-inflated negative binomial). We found that having more jail bookings was associated with fewer primary care visits, but not one-time access, even controlling for time out of community, age, insurance, and other demographic characteristics. This finding was driven by subgroups with chronic disease such as hypertension, obstructive lung disease, and diabetes, who most need regular primary care. Being Black retained an independent effect, even controlling for bookings and other variables, and was also associated with fewer primary care visits, though not one-time access. To promote primary care utilization among individuals who have the combined challenges of repeated jail involvement and chronic disease, it is crucial to focus on engagement, as much as formal access. Access to health insurance alone will not resolve the problem; Medicaid expansion should be coupled with specialized, tailored support to promote engagement in primary care.

Infectious Disease Education in a Carceral Setting: Insights from a Jail-Based Medical Student-Led Health Literacy Initiative.

Incarceration is associated with adverse health outcomes, including higher rates of infectious diseases. Poor health literacy in this population is a likely contributing factor, making health education a potential tool to help address these health disparities. This article aims to describe the implementation of a novel medical student-led educational initiative in the jail setting as a tool to promote health literacy and decrease the infectious disease burden in the correctional setting. A four-part infectious disease health education curriculum was developed and tailored to a carceral context. The course was offered on a voluntary basis to members of a reentry program at a local county jail. Pre- and postcourse surveys were used to evaluate the course effectiveness. The results demonstrated a statistically significant increase in the participants' reported confidence for recognizing the symptoms of and seeking appropriate treatment for common infections, including sexually transmitted, respiratory, and blood-borne infections. To the authors' knowledge, this is one of the first medical student-led programs of its kind to be described in existing literature. This program hopes to continue refining its curricular offerings and serve as a model for medical schools across the country to increase trainee engagement.

Hidden scars: the persistent multifaceted health and psychosocial consequences for Syrian torture survivors.

Background: The impact on the physical and mental health of those who survived torture and their close circles in the Syrian regime's detention facilities remains under-studied.Objective: This qualitative study explored Syrian refugees' narrations of captivity and torture, and the consequences of such extreme traumatic events on their physical and psychosocial health.Method: Thirteen audio-recorded interviews were conducted in Arabic with Syrian refugees. Study participants were at least 19 years of age, resided in diverse urban areas of Jordan, had experienced captivity and torture in Syrian detention facilities, and voluntarily agreed to participate in the study. Participation was anonymous, only oral consent was required, and no incentives were provided to participants. Interviews were transcribed and translated into English by a team of researchers, followed by analysis of repetitive themes according to the narrative paradigm.Results: Analysis of interviews elicited three major themes: extreme traumatic experiences of torture, and its physical and psychosocial health consequences. The first major theme was divided into two sub-themes: torture experienced by the participants themselves, and torture experienced by participants' close circles. The second major theme, pertaining to physical health, was divided into two sub-themes: acute and chronic health sequelae. The third major theme, related to psychosocial health, was divided into four sub-themes: mental health symptomatology, impacts on professional life, impacts on interpersonal relationships, and social consequences.Conclusions: Torture experiences of Syrian refugees had adverse consequences for the physical and psychosocial health, functioning, and the overall well-being of survivors and their close circles. Interventions may seek to improve both the acute and chronic health consequences, as well as the mental health symptoms and associated impacts on livelihood, professional, and relationship dynamics. They should span clinical, legal, and advocacy spheres, given that a holistic approach may contribute immensely to survivors' healing process.

The Nazi regime in Lithuania: recovery of agricultural obligations imposed

The purpose of this study is to investigate methods and means of recovery of imposed agricultural obligations. The aim of this paper is to analyse the methods and means for recovery of imposed agricultural obligations in Lithuania, occupied by military forces of Nazi Germany. To achieve the aim, the following objectives have been set: 1) to discuss adaptation of production of agricultural products to meet needs of the war in Lithuania under the Nazi regime; 2) to analyse the methods and means used by occupational Nazi authorities for recovery of agricultural obligations imposed on farmers of Lithuania; 3) to discuss other obligations imposed (other than delivery of agricultural products) on Lithuanian farmers, analyse methods and means for their recovery; 4) submit the exhaustive and reliable statistics on recovery of imposed obligations related to delivery of agricultural products. The topic chosen is a relevant and new one, as this problem has not been presented exhaustively in Lithuanian historiography. First of all, we lack a generalized analysis on the entire Lithuania scale, analysis which must be more detailed, based on archive or reliable statistical data related to practical application of the mechanism of recovery of agricultural obligations (primarily aiming at agricultural products) imposed. This article aims at filling these and other gaps in relevant historiography. During the research the following conclusions have been drawn: 1. In the case of Germany victory in the war, the territories of all Baltic states, including Lithuania, were to be included into the Nazi Reich. During the wartime, the economy of these countries had to serve demands of the Vermacht and meet other Reich needs, irrespective of the interests of the local people and local economies. It had not been planned to create a considerable consumer goods industry. These countries had to be cheap labour sources and base for provision of raw materials, as well as a market for realization of German industry products.2. The essence of the Nazi agricultural policy in the occupied Lithuania meant a unilateral demand to increase production of basic food products and raw materials in order to provide the German troops as well as local residents and Germans in Germany with food products. The Nazi imposed on farmers various obligations related to agricultural products and various equipment (mobilization of horses with carts and harnesses, obligations of manual work and transport, etc.)3. Civil occupational Nazi authorities adapted Lithuanian municipal system to meet their agricultural needs during the wartime. The occupational authorities through threatening the officers of Lithuanian municipal system with penalties and negative consequences related to agriculture and farmers, using the help of Lithuanian officers, managed to recover a huge amount of agriculture products from this country agriculture sector. Whereas Lithuanian municipal officers of higher rank were forced to apply constantly the psychological pressure or even coercion on their own subordinates and colleagues of lower rank.4. In order to recover agricultural obligations fulfilment, the occupants applied both repressive and promoting measures. Among repressive ones, farmer removal from his/her farm should be mentioned as well as requisition of agricultural products, cash penalties, farmers suing with the German Special Court, forcible confining in detention facilities, forced-labour camps or even killing by firing squad. Especially famous for farmers killing by firing squad was H. Wulff, the commissar of Vilnius county district. By killing the farmers, the occupants sought to intimidate the villagers so that they would better fulfil the obligations imposed.5. To perform recovery of fulfilment of imposed agricultural obligations, the following promoting measures used to be applied: issue of ownership documents, granting the possibility of acquisition of industrial goods, etc.6. The Nazi failed to convert Lithuanian farmers into obedient executors of alien will. Due to harsh conditions of the wartime and sabotage of Lithuanian farmers in order to protect their farms from the complete deterioration, occupational government of the Nazi each economic year failed to collect from Lithuanian villages planned agricultural products contingencies irrespective of requisition of the large part of agricultural production of this country.

“The mother seems to traumatize her child”: Examining empathy, denial, and responsibility in day-to-day encounters of families and staff in immigration detention in Canada

This paper examines encounters of mothers and their children with detention facility staff during our fieldwork in immigration detention centres in Canada. We sought to understand how detainees and institutional staff understand each other and their roles within the broader system. Using a critical ethnographic frame that views the inner psychic worlds of subjects as contingent upon larger systems of power and oppression we organize our data around narrative and content themes. Our findings suggest that guards and staff see their roles as protectors of children, even as they communicate implicitly that these families are risks. Further, we propose that staff tend to project the aggressor onto the Other, in this case, migrant mothers, as a way to cope with the moral distress of witnessing the suffering of detained children, and with the burden of potential complicity. By describing how empathy, denial and responsibility are negotiated in these custodial spaces, we analyze the ways these micropolitical encounters can illuminate larger trends in the representation and reception of migrants with important implications for mental health care and border control practices and policy more broadly.

НЕКОТОРЫЕ АСПЕКТЫ ДЕЯТЕЛЬНОСТИ ПРАВОСЛАВНЫХ СВЯЩЕННОСЛУЖИТЕЛЕЙ В ОБЩЕСТВЕННЫХ НАБЛЮДАТЕЛЬНЫХ КОМИССИЯХ ПО ОБЕСПЕЧЕНИЮ ПРАВА НА СВОБОДУ ВЕРОИСПОВЕДАНИЯ ПОДСЛЕДСТВЕННЫХ И ОСУЖДЕННЫХ

On January 26, 2024, within the framework of the XXXII International Christmas Educational Readings «Orthodoxy and Domestic Culture: losses and gains of the past, the image of the future», the Public Chamber of the Russian Federation held a round table hearing on the topic «Participation of clergy in the work of public monitoring commissions (ONCS) on public control over ensuring human rights in places of forced detention». The trends of changes in the legal status of the clergy in the penal enforcement system of the Russian Federation are revealed. The main directions and forms of participation of the clergy in the realization of the right of persons under investigation and convicted to freedom of conscience and religion are considered. The report pays special attention to the analysis of the main problems in the implementation of this right in pre-trial detention facilities. Proposals have been made to improve legal regulation and law enforcement practice in the field of interaction between institutions and bodies of the penal enforcement system with traditional centralized religious organizations in Russia

Psychopathy traits explain variance shared between features of substance use disorders and violence.

There is a substantial research literature on identifying risk and protective factors for violence perpetration. Substance use disorders have long been identified as constituting a significant predictor of violent behaviour. Psychopathy traits have also been similarly recognised, but inter-relationships between psychopathy traits, features of substance use disorders and violence have been little explored. To determine the degree to which shared variance between substance dependence symptoms and violence, as indicated by criminal charges for violent offences, among jailed men can be explained by psychopathy traits. Features of dependence on substances in three drug classes (alcohol, cannabis and cocaine) were assessed in a sample of 682 men in a county jail awaiting trial on criminal charges, many for violent offences. Statistical comparisons of zero-order and partial correlations tested whether accounting for psychopathy total and facet scores, assessed by the Psychopathy Checklist-Revised (PCL-R), affected associations between substance dependence symptoms and violent charges. Total PCL-R scores accounted for a significant proportion of the shared variance between the history of criminal charges for violence offences and lifetime substance dependence symptoms in all three drug classes. At the facet level, controlling for ratings on the interpersonal and modified antisocial facets reduced the association between criminal charges for violent offences and symptoms of cocaine dependence; controlling for ratings on a modified antisocial facetalso attenuated links between alcohol and cannabis dependence symptoms and history of charges for violent offences. These findings build on the sparse literature to date on the role of psychopathy traits on relationships between features of substance use disorders and violence. Given that the observed connection between substance dependence symptoms and charges for violent offences is partly accounted for by individual differences in psychopathy traits, it follows that effective treatment for those traits may be useful, perhaps essential to reducing links between features of some substance use disorders and violent offending.

ЗАКОН ОБ УЧРЕЖДЕНИЯХ ОБЪЕДИНЕННОГО ТИПА: ВЗГЛЯД ПАРЛАМЕНТАРИЯ

Federal Law No. 126-FZ of May 29, 2024 “On Amendments to Article 6 of the Law of the Russian Federation “On Institutions and Bodies of the Penal Enforcement System of the Russian Federation”” provides for the creation of institutions of a combined, so-called hybrid type. It is planned to concentrate correctional institutions and pre-trial detention facilities in a single center, modernize and unify existing technologies in the field of regime maintenance and development of the production sector, as well as provide a reasonable approach to creating conditions for the detention of convicts, suspects and accused. Correctional institutions of the combined type are beneficial to the state, since the organizational and financial costs of moving convicts and escorting them are reduced; the efficiency of logistical support of the institution is increased; forces and means for the protection of convicts are being saved; it is possible to create modern production facilities that could employ all categories of convicts, while solving the problem of eliminating dilapidated facilities in order to improve the conditions of detention of convicts, suspects and accused. The article discusses some problematic issues that will have to be taken into account when implementing the reform. The main thing is the additional allocation of material and financial resources for the construction of centers or the reconstruction of old institutions; the creation of a modern socio-economic environment for employees working in the institution and their family members; a new type of head will be required, the expansion of staff with high qualifications, knowledge, skills and relevant experience; it is necessary to ensure the isolation of various categories of convicts, security and maintenance of the regime. The ambiguous attitude of local residents towards such construction should also be taken into account. The opinion that educational colonies, medical correctional institutions and detention houses could also be located in joint- type institutions was not supported by deputies of the State Duma. Nevertheless, this issue is not completely closed. It is subject to broader discussion with the participation of specialists, including on the pages of this journal, which may allow the relevant draft law to be submitted to the State Duma.

Deaths in jail: a retrospective analysis of autopsies performed at the Legal Medicine Unit of Pavia (1999-2022).

The high rate of incarceration, now exceeding 11.5 million people worldwide, has raised concerns about the conditions within penal institutions, such as the consequences of incarceration on the person. This retrospective study aims to investigate the issue of death in custody, exploring the relationship between incarceration, health vulnerabilities, and death from the forensic pathologist's point of view. We analyzed, from a forensic, clinical and toxicological perspective, 86 cases of deaths in detention facilities in North-Western Italy from 1999 to 2022. The analysis has shown that suicide, mainly committed by hanging, plastic bag suffocation and butane intoxication, represents the leading type of violent death (52%), followed by accidental deaths (16%). On the other hand, cardiovascular diseases are the leading cause of natural deaths (42%), followed by infectious diseases (especially HIV-related). The present study identifies the most frequent and critical situations and risk factors related to death in custody and the profile of the inmate who is at a higher risk of death, allowing to highlight the issues to be addressed from a public health point of view. On the whole, it calls for comprehensive reforms, aligned with international human rights standards, addressing mental and physical care gaps, improving correctional officers' education, and training, and focusing on rehabilitation with well-being and dignity.

Naloxone vending machines in county jail

IntroductionThe overdose epidemic in the United States has intensified following the introduction of illicitly manufactured fentanyl to drug markets with recent estimates indicating 110,000 deaths in 2022 and longer-term trends adversely impacting national life expectancy. A period of incarceration has been identified as a critical touchpoint for overdose prevention given its strong association with risk of overdose. In this paper we describe efforts funded by the Centers for Disease Control and Prevention (CDC) Overdose Data to Action (OD2A) grant to design and implement naloxone vending machines that provide free naloxone within county jails to returning citizens and those visiting county jail facilities. MethodsThis study utilized three sources of data. First, we describe the results of a pre-implementation survey administered by technical assistance providers to 18 jails across the state of Michigan. Second, among the 6 jail facilities that accepted a naloxone vending machine we examine administrative data from Michigan Department of Health and Human Services on naloxone orders to look at changes 6-months before and after implementation. Third and lastly, we conducted semi-structured interviews (N = 6) with jail administrators (i.e., County Sheriffs) on the barriers and facilitators to implementing a naloxone vending machine. ResultsSix facilities indicated they would accept a vending machine to distribute free naloxone. Overall, the total number of naloxone box orders that were distributed across all jail sites increased by 63.5 % from 4104 boxes pre-naloxone vending machine to 6708 boxes post-naloxone vending machine implementation. Qualitative interviews revealed that prior naloxone distribution efforts and foundational knowledge about opioids, overdose, and naloxone emerged as facilitators for vending machine implementation. ConclusionThis study illustrates the utility of policy-driven funding strategies aimed at mitigating accidental overdose deaths among a high-risk population while building community naloxone saturation efforts.

Likelihood of COVID-19 Outbreaks in US Immigration and Customs Enforcement (ICE) Detention Centers, 2020‒2021.

Objectives. To determine facility-level factors associated with COVID-19 outbreaks in US Immigration and Customs Enforcement (ICE) detention centers. Methods. We obtained COVID-19 case counts at 88 ICE detention facilities from May 6, 2020, through June 21, 2021, from the COVID Prison Project. We obtained information about facility population size, facility type (dedicated to immigrants or mixed with other incarcerated populations), and facility operator (public vs private contractor) from third-party sources. We defined the threshold for a COVID-19 outbreak as a cumulative 3-week incidence of 10% or more of the detained population. Results. Sixty-three facilities (72%) had at least 1 outbreak. Facilities with any outbreak were significantly more likely to be privately operated (P < .001), to have larger populations (113 vs 37; P = .002), and to have greater changes in their population size over the study period (‒56% vs -26%; P < .001). Conclusions. Several facility-level factors were associated with the occurrence of COVID-19 outbreaks in ICE facilities. Public Health Implications. Structural and organizational factors that promote respiratory infection spread in ICE facilities must be addressed to protect detainee health. (Am J Public Health. 2024;114(9):909-912. https://doi.org/10.2105/AJPH.2024.307704).

Patient Perceptions of Hepatitis C Screening and Diagnosis While in a County Jail.

Prior research in the Santa Clara County (SCC) Jail showed that knowledge of hepatitis C virus (HCV), perception of risk, and perceived coercion impacted participation in routine HCV screening; however, the experiences of patients undergoing screening were not assessed. The purpose of the study was to understand patient perceptions of undergoing routine viral hepatitis screening and receiving a diagnosis of HCV while incarcerated. A qualitative design was employed using semi-structured interviews of individuals newly diagnosed with HCV via routine screening in the SCC Jail between March and November 2023. The data were analyzed using thematic analysis. Of the 15 participants, most were within the 35 to 44 (47%) and 25 to 34 (40%) age ranges, were White or Caucasian (47%), and all were male. Nine themes emerged: (1) risk perception as a motivator for testing, (2) testing convenience to maintain health, (3) minimal to no prior testing experience, (4) mixed experiences testing in the jail, (5) negative to neutral reactions to HCV diagnosis, (6) intrinsic motivation to get treated, (7) basic HCV knowledge after diagnosis, (8) seamless treatment experience in the jail, and (9) barriers to continuing care upon release. The HCV screening process, including disclosure, education, and treatment initiation, was positively received among participants.

Migration flows and concrete walls: an archaeological perspective on early migrant detention facilities. The C.P.T “Regina Pacis” (Italy, Puglia)

ABSTRACT Over the last few decades, Italy has been at the forefront of mass migration flows. Starting from the late 1990s, facilities for the detention and expulsion of undocumented migrants have been established. In this paper, we analyse one of the earliest examples of such structures in the Mediterranean: the former temporary holding facility (or C.P.T. Centro di Permanenza Temporanea) ‘Regina Pacis’ located in south-eastern Italy. In 1997, the structure was repurposed into one of the largest C.P.T in Italy until its closure in 2005. Through an approach that combines archaeology and ethnography, we aim to understand the role that material culture played in subjugating and controlling the life of the migrants, attempting to evaluate, at the same time, the impact that the facility had on its hosting community.

The interdependence of caring, safety, and health in correctional settings: Analysis of a survey of security staff in a large county jail system

The health of incarcerated populations is intertwined with the health of security staff, but the social mechanisms, and especially the specific interventions, that might mitigate these health harms are underexplored. We examine one possible mechanism of interrelated health harms: whether and how jail security staff are willing and able to care for mentally ill detainees. We hypothesize that the attitudes of security staff towards care affect the well-being of everyone in a jail setting—staff, as well as detainees. Analyzing 539 anonymous respondent surveys administered to a stratified cluster sample of security staff working in a large U.S. county jail system, we (1) describe the prevalence of a perceived duty to care and availability of caring resources among security staff and (2) analyze whether variations in a duty to care and caring resources predict outcomes associated with staff and detainee well-being. Across five maximum likelihood models estimated, both perceived duty to care and availability of caring resources are significantly associated with collaborative relationships with medical staff, increased perceptions of personal safety, decreased frequency of hostile encounters, and better self-reported health outcomes. Our models explain 20 percent of the variation in self-reported health outcomes (R2 = .20), a meaningful effect of care on security personnel's well-being. Our findings suggest security staff have an often-overlooked duty to care akin to that experienced by healthcare staff. Among healthcare staff, dual loyalty trainings have successfully amplified caring duties relative to security duties; similar trainings for security staff might better leverage their caring duties to improve both staff and detainee well-being.

Gonorrhea and Chlamydia Opt-Out Screening of Justice-Involved Females During Intake at the Los Angeles County Jail: The Pivotal Role of Correctional Health Systems.

Chlamydia and gonorrhea are two of the most common sexually transmitted infections (STIs) worldwide, presenting major public health challenges and resulting in billions of dollars in direct medical costs in the U.S. Incarcerated females have a particularly elevated risk of these infections, which can result in serious sequelae if left untreated. On December 13, 2021, the Los Angeles County Jail system began offering opt-out urogenital chlamydia and gonorrhea screening to all newly incarcerated females. We retrospectively analyzed electronic health record data for completed urogenital chlamydia/gonorrhea screening among newly incarcerated females between December 13, 2021, and May 31, 2023. We used multivariable logistic regression to examine the association of STIs and treatment non-initiation outcomes with various demographic and self-reported variables. Of the 13,739 female entrants offered STI testing, 10,717 (78%) completed screening, with 1151 (11%) having a chlamydial infection, 788 (7%) having a gonococcal infection, and 1626 (15%) having >1 infection. STI positivity was associated with age 18-34, reported houselessness, amphetamine use, and history of a positive prior treponemal antibody test. STI treatment non-initiation was associated with shorter jail stay for both chlamydial ([aOR] = 87.4, 95% CI (34.2, 223.2)) and gonococcal ([aOR] = 9.0, 95% CI (5.2, 15.7)) infections. The STI prevalence among female detainees tested was manyfold higher than that of the general population. The implementation of routine opt-out STI screening in carceral settings provides a unique opportunity to benefit the health of both the correctional population and potentially that of the surrounding community.

Child Migrants in Family Detention in the US: Addressing Fragmented Care.

Migrant children in family detention facilities often experience frequent relocations and prolonged stays in precarious living conditions. This frequent relocation results in fragmentation of necessary medical care, leading to delays and inadequate medical care. We aim to highlight the critical need for comprehensive medical documentation in immigration detention facilities, a fragmented health care system and potential harm to these children without appropriate medical documentation. We conducted a retrospective review of 165 medical records from children detained at the Karnes County Family Residential Center between June 2018 and October 2020 to evaluate the adequacy of pediatric medical documentation in an Immigration and Customs Enforcement (ICE) family detention facility. Specific areas of interest included acute care, nutrition, immunization, developmental screening, and tuberculosis screening. Simple descriptive statistics were used to analyze the data. Only 25% of 418 acute medical care visits included specific diagnoses. There was no documentation regarding follow-up recommendations upon release. 97% of children had a chest X-ray completed for tuberculosis screening, however no follow-up recommendations were documented for those with granulomas. Vaccination histories were inconsistently documented. No nutritional categorizations were completed despite 16% of children being at risk for malnutrition or already malnourished. Our findings revealed significant gaps in documentation, particularly in medical decision-making and clinical reasoning. In a fragmented medical system, inadequate documentation can result in avoidable errors in diagnosis and management. Improving documentation practices is crucial to ensure that all children, regardless of immigration status, receive quality healthcare aligned with national and international standards.

Most of them care about us, but not everyone does! Creating a positive living group climate in German youth prison − A longitudinal study

This study represents the first longitudinal data of living group climate in a Germany youth detention centre in terms of the support from staff, opportunities for growth, repression and group atmosphere among inmates. Participants were male adolescents (N = 709) living in supervised living groups. They completed the German version of the PGCI at 8 different moments over a period of 5 years, from 2014 to 2019. Four separate piecewise multilevel regression analyses revealed a significant increase of support. Repression decreased significantly during the first three measurement waves, and subsequently showed a slight but significant increase, while neither growth nor group atmosphere significantly changed. The present results are novel in their character as they explicitly add to the limited body of knowledge on longitudinal changes in living group climate in youth detention facilities.