Individuals In Custody Research Articles

P-2182. Assessing Hepatitis A Virus (HAV) and Hepatitis B Virus (HBV) Screening, Immunity, and Vaccination in People Living with Human Immunodeficiency Virus (HIV) in the Illinois Department of Corrections (IDOC)

Abstract Background Individuals in custody are highly susceptible to vaccine-preventable diseases, including hepatitis A virus (HAV) and hepatitis B virus (HBV). In the Illinois Department of Corrections (IDOC) HIV Telemedicine Clinic, people are screened for HAV/HBV, providing an opportunity to recommend vaccines in those without immunity. Methods This retrospective cohort pre-post study included adults living with HIV who followed in the IDOC HIV Telemedicine Clinic during two time periods, 01/01/2019 - 12/31/2019 and 01/01/2022 – 12/31/2022, with a 9-month follow-up period to account for screening and vaccination recommendations. Patients were excluded from primary endpoint analysis if they had chronic HBV infection. The primary objective was to compare the rates of vaccination and immunity to HAV and/or HBV among individuals in custody living with HIV in 2022 to prior data in 2019, where standardized recommendations for serologic screening and vaccination were not routinely performed. Secondary endpoints included the number of individuals receiving HAV/HBV screening, acceptance of vaccination if recommended, and documented barriers to vaccination. Statistical analysis included descriptive statistics, Chi-squared test, and Student’s t-test. Results A total of 436 patients were included in the 2019 cohort and served as historical control data. Of 341 patients screened for inclusion in the 2022 cohort, 300 were included. Baseline characteristics are presented in Table 1. 79% and 70% of patients were immune to HAV in 2019 and 2022, respectively (p = 0.02). 65% and 71% of patients were immune to HBV in 2019 and 2022, respectively (p = 0.12). Overall, the number of patients immune to both HAV and HBV were similar between the two cohorts with 52% in 2019 and 53% in 2022 (p = 0.89). On the other hand, the percentage of patients who had no immunity to both HAV and HBV was 8% in 2019 and 12% in 2022 (p = 0.08). Patient refusal was the main barrier to vaccination. Other secondary outcomes for 2022 are outlined in Table 2. Conclusion Overall, HAV and HBV immunity did not significantly increase in 2022. Results suggest that a major opportunity still exists to screen and provide vaccination to individuals in custody, but routine serologic screening can lead to improved HAV and HBV immunity rates. Disclosures Scott Borgetti, MD, GSK: Grant/Research Support

P-1445. Evaluation of Achievement of Metabolic Goals in People with Human Immunodeficiency Virus (HIV) in the Illinois Department of Corrections (IDOC)

Abstract Background The UIC-IDOC clinic is an interdisciplinary telemedicine clinic addressing HIV care needs of individuals in custody. The UIC-IDOC care team makes recommendations to medical providers regarding disease states outside of HIV. HIV contributes to increases in cardiovascular (CV) risk, along with diabetes (DM), hypertension (HTN), and hyperlipidemia (HLD). Managing comorbidities in patients with HIV (PWH) can lead to an overall reduction in CV risk. The goal of this study was to provide evidence that follow-up with IDOC telemedicine clinic had positive outcomes on achieving metabolic goals in individuals in custody. Methods This was a pilot retrospective cohort study evaluating the effectiveness of an interdisciplinary approach in achieving A1C, blood pressure, or lipid panels among PWH in custody. Adults diagnosed with HIV, on antiretroviral therapy (ART), and with a diagnosis of DM, HTN, and HLD were included between 1/1/2021 and 6/30/2022. The primary outcome evaluated the achievement of metabolic goals within 1 year compared to baseline, while the secondary outcome assessed medication optimization to guideline-recommended therapy for any diagnoses above. Results 102 patients were included. Baseline characteristics are presented in Table 1. Notably, most PWH reported ART adherence and achieved viral suppression. For the primary outcome, there was no difference in the achievement of metabolic goals 1-year post-follow-up for all disease states, DM (p=0.347), HTN (p=0.833), and HLD (p=0.935). For our secondary outcome, there was a significant difference in the optimization of hypertensive medications by the last visit, Table 2. Conclusion Findings from this study offer insights into optimizing HIV care delivery within correctional settings and enhancing outcomes for this patient population. Based on this data, recommendations being made by the UIC-IDOC telemedicine clinic may not be consistently implemented. However, our study shows an interdisciplinary clinic's role in the medication management of individuals in custody and the potential to assist in reducing cardiovascular risk in PWH, especially in people with HTN. Furthermore, a high degree of viral suppression was demonstrated for this study which may predict adherence to medications for metabolic diagnoses. Disclosures Scott Borgetti, MD, GSK: Grant/Research Support

Medical Decision Making in Correctional Facilities: Highlighting Gaps and Advocating for Policy Change.

In the United States, a disproportionately high number of incarcerated individuals suffer from serious mental illnesses, substance use disorders, chronic medical conditions, infectious diseases, and traumatic brain injuries. Correctional facilities are often ill-equipped to address the incarcerated community's physical and mental health needs. Current laws and policies remain outdated and do not adequately address the complex health issues faced by incarcerated individuals, particularly the aging and terminally ill patients in correctional settings. We present a case of a male with schizophrenia whose ongoing psychiatric symptoms impaired his decisional capacity, leading to him to refuse medical treatment for an initially treatable medical condition, ultimately resulting in his death due to the lack of a surrogate decision-maker. This case underscores the urgent need for policy revisions to assign medical decision-making authority for individuals in custody and highlights potential interventions to bridge existing gaps in care for this population.

Suicide-Related Outcomes Among Adults in Custody: An Umbrella Review of Systematic Literature Reviews

We conducted a comprehensive umbrella review including all published meta-analyses and systematic reviews on suicide-related outcomes among adults in custody. Eligible studies were searched for in major scientific databases following the PRISMA method up to February 2023. The quality of each study was assessed using the AMSTAR-2 protocol. Twenty studies were included, consisting of 11 meta-analyses and nine systematic reviews. Factors associated with suicide outcomes among individuals in custody were categorized into five domains: clinical status, historical, custodial, criminological, and prevention. However, all systematic studies reported considerable heterogeneity (I2 > 50%–85%). Most systematic literature reviews and/or meta-analyses showed moderate quality based on AMSTAR-2. This umbrella review highlights individual factors (in the clinical status and historical domain), contextual factors (in the custodial and criminological domains), and protective factors (in the prevention domain) to provide a clearer understanding of the prison-related domains involved in the development and maintenance of suicide-related outcomes.

Bodies of evidence: The ‘Excited Delirium Syndrome’ and the epistemology of cause-of-death inquiry

“Excited Delirium Syndrome” (ExDS) is a controversial diagnosis. The supposed syndrome is sometimes considered to be a potential cause of death. However, it has been argued that its sole purpose is to cover up excessive police violence because it is mainly used to explain deaths of individuals in custody. In this paper, we examine the epistemic conditions giving rise to the controversial diagnosis by discussing the relation between causal hypotheses, evidence, and data in forensic medicine. We argue that the practitioners’ social context affects causal inquiry through background assumptions that enter inquiry at multiple stages. This analysis serves to better understand the wide usage of the controversial diagnosis of ExDS.

Keynote Speech at Rewriting the Sentence II Summit

Federal Bureau of Prisons Director Colette Peters spoke at the Rewriting the Sentence II Summit on October 17, 2023. Transcribed remarks include the Bureau of Prisons’ alignment with the criminal legal reform community in thinking differently about the experience of incarceration for individuals in custody and opportunities for reform that support positive and rehabilitative outcomes.

Correctional Psychiatry: Addressing the Mental Health Needs of Justice-Involved Individuals in Custody and the Community.

Correctional Psychiatry: Addressing the Mental Health Needs of Justice-Involved Individuals in Custody and the Community.

Time and Care: A Qualitative Exploration of Prisoners’ Perceptions of Trauma-Informed Care in Women’s Prisons

Women’s prisons in England have been working toward providing trauma-informed and responsive care for individuals in custody due to high rates of psychological trauma within the population. This study aimed to explore how women experience trauma-informed and responsive care in prison. Interviews with 51 participants from three prisons were undertaken. Three main themes were identified using thematic analysis: time—a precious commodity; feeling cared for; and trauma-informed staff training. Participants identified barriers to staff providing trauma-informed care: scarcity of time, and staff behavior undermining the principles of trauma-informed care. Enablers included the availability of time with staff and staff showing empathy and understanding. Most participants expressed the view that staff trauma training lacked impact. These findings suggest that the goal of providing trauma-informed and responsive care may be far from being realized and that resources, prison practices and cultures should be the focus of change before staff training can be effective.

Self-harm risk screening on prison entry: assessing the predictive validity of self-harm history and recent ideation in men and women

PurposeRates of self-harm are elevated in prison, and there is limited evidence to support the efficacy of brief risk screening at reception to predict and prevent self-harm. This study aims to examine the predictive validity of the self-harm/suicide screening items embedded in a prison mental health screening tool from two key domains strongly associated with risk: previous suicidal/self-harm behaviour, and recent ideation.Design/methodology/approachA sample of men and women were screened on entry to prison, with eight screening items covering the two key domains of risk. Follow-up data on self-harm incidents were collected for 12 months post-screening. The predictive validity of individual screening items, item combinations and cumulative screening score was examined for the overall sample and for men and women separately.FindingsIndividual screening items across the two domains were all strongly associated with self-harm in the follow-up period, with odds ratios varying from 2.34 to 9.24. The predictive validity of both individual items, item scores and item combinations demonstrated high specificity but low to moderate sensitivity, and modest area under the curves (AUCs). Predictive validity was generally better for men than women; however, differences were not statistically significant.Practical implicationsIdentifying those at risk of self-harm in prisons remains challenging and brief universal screening at prison entry should be only one component of a broader prison risk assessment and management strategy.Originality/valueTo the best of the authors’ knowledge, this study is one of very few to prospectively examine self-harm behaviour following risk screening. Predictive validity was examined in a representative sample of individuals in custody, and for men and women separately.

Untangling the relationship between child maltreatment and criminal behavior: executive functioning as mediator

ABSTRACT There is evidence that childhood maltreatment (CM) is an important risk factor for adult criminal behavior. However, little is known about the cognitive processes mediating this relationship. This study examined the mediating role of executive functioning (EF) on the relationship between CM and history of criminal behavior on a sample of 334 male individuals in custody from Uruguay. Preliminary results showed that CM was significantly associated with past criminal behavior in all multivariate models. The mediation analysis found that behavioral regulation had a significant mediating role while the metacognition and EF total score did not. Finally, the inhibition domain was the strongest mediator. This suggests that CM is an important risk factor that needs to be considered in Uruguay, and addressing behavioral regulation may also help to address some of the long-term consequences of CM and targeting deficits in inhibition could be a potential target for treatment for individuals that commit criminal offenses.

Pattern Of Infections In Custodial Deaths – A Forensic Autopsy Study

Background: In a country like India, the prisoner cells are not well structured. For instance prisons are known to be a high risk environment for infections like tuberculosis (TB), HIV, HCV, HBV etc. due to overcrowding, low levels of nutrition, poor infection control and lack of accessible healthcare services. This study is an effort to know about the pattern of infections in custodial death cases detected during post mortem examination. Aims and Objectives: To determine the common infections and to know the mortality caused by infections among prisoners in custody, people in police custody and mentally ill patients in mental health institute in Punjab.Methods:This cross sectional study of 100 cases of custodial deaths from 1st Jan 2019 to 4thMay 2021, was carried out in the Forensic Medicine department in collaboration with department of Microbiology, Govt. Medical College, Amritsar.Results:Klebsiella Pneumoniae (37.5%) is more common in age group of 10-30 years while Staphylococcus Aureus (35.9%) infection was more common in the age group of 31 to 50 years. Incidence of positive growth of infections was slightly more in female inmates (76.9%) as compared to the males (75.9%). Inmates from urban area background showed more growth of Staphylococcus Aureus (35.7%) than from rural area background(25%).Conclusions:Timely medical diagnosis and treatment of each prisoner with availability of good doctors are the important issues relating to the healthcare of the individuals in custody.

British Columbia Provincial Corrections’ Response to the COVID-19 Pandemic: A Case Study of Correctional Policy and Practice

ABSTRACT Health and justice officials across North America have described correctional institutions as petri dishes for the transmission of COVID-19. Individuals in custody commonly have health profiles that are more compromised than those of the general population. Institutional infrastructure issues and custody counts that create barriers to protocols, including physical distancing measures, that health authorities recommend to limit the spread of the virus compound these profiles. Many correctional authorities have struggled to implement strategies to mitigate infection rates among custodial populations. This paper examines the strategies employed by one provincial correctional authority in Canada that has to date successfully prevented the spread of COVID-19 in custody centers by adopting a health-informed approach to the crisis rather than a traditional justice-informed response. The findings highlight practices that can inform the responses of other jurisdictions as the pandemic continues and identify areas of future research on the effects of COVID-19 on incarcerated persons, correctional and health-care staff, and communities.

Prison Health as Public Health in Ontario Corrections

The majority of incarcerated individuals in Canada, and especially in Ontario provincial correctional institutions, are released into the community after a short duration in custody. Adult correctional populations have generally poor health, including a heightened prevalence of mental health and substance use disorders. There are legal and ethical obligations to address health care needs of incarcerated individuals, and also public health benefits from ensuring adequate, appropriate, and accessible health services to individuals in custody. The Independent Review of Ontario Corrections recommended the transformation of health care in Ontario provincial corrections in 2017, including transferring health service responsibilities to the Ministry of Health and Long-Term Care. The Correctional Services and Reintegration Act, 2018, would affirm the provincial government’s obligation to provide patient-centred, equitable health care services for individuals in custody. We encourage the Government of Ontario to proclaim the Act and continue the momentum of recent reform efforts in Ontario.

Prison Officer Self-Legitimacy and Support for Rehabilitation in Ghana

Legitimacy remains a principal issue for prison researchers and managers. However, prison legitimacy literature tends to focus on views held by individuals in custody. Research on prison officer Self-Legitimacy—that is, the prison officers’ belief that the authority vested in them is morally right—remains scanty. Drawing on data from a survey of 1,062 prison officers in Ghana, this study examined both the correlates of prison officer Self-Legitimacy and the links between Self-Legitimacy and Support for Rehabilitation of individuals in custody. The results of multivariate analyses showed that having good Relations with Colleagues and being treated fairly by supervisors enhanced prison officers’ Self-Legitimacy. In turn, Self-Legitimacy was found to increase officers’ Support for Rehabilitation. Finally, perceived Fair Treatment by Supervisors and positive Relations with Individuals in Custody were associated with increased Support for Rehabilitation. The implications of these findings are discussed.

Who Arrests those Accused by the ICC?

In a world in which war crimes, crimes against humanity, and genocide are not uncommon, the institution that was set up to have jurisdiction over them is in danger of being unable to discharge its mandate. Put starkly, the International Criminal Court (ICC) suffers too frequently from an inability to arrest or otherwise detain alleged perpetrators, whether the prosecutor is acting proprio motu or is following a reference to the court by a state party or the Security Council. The situation of Saif al-Islam Gaddafi is a case in point: notwithstanding the Security Council's referral of Libya to the ICC, at least as a member of the public it is difficult to detect any substantial international pressure that has been applied to have Gaddafi transferred to the Court; instead, he has been mooted as a candidate in future presidential elections. In total, the Court has issued thirty-two arrest warrants and nine summonses to appear, yet has held only nine individuals in custody, with fifteen still at large. The fugitives include citizens of the Democratic Republic of Congo, Uganda, Sudan, Kenya, Libya, and the Ivory Coast. Once the present trials before the court have concluded, there is only one case potentially waiting in the wings. A sole outstanding individual, Al-Hassan Ag Abdoul Aziz Ag Mohamed Ag Mahmoud from Mali, has made an initial appearance, and later this year the pre-trial stage of his case should commence; otherwise, there are simply the three trials in progress. However, I urge careful reflection before the Court is blamed for periods in which its docket of cases is lean.

Aboriginal prisoners and cognitive impairment: the impact of dual disadvantage on Social and Emotional Wellbeing.

Negligible information is available regarding the Social and Emotional Wellbeing (SEWB) needs of Aboriginal Australian individuals in custody with cognitive impairment. This is problematic given that Aboriginal people with cognitive impairment often experience dual disadvantage in the context of the justice system. This study sought to ascertain the relationship between cognitive impairment and mental health/cultural needs (SEWB) Aboriginal and Torres Strait Islander people in custody. A sample of 122 Aboriginal and Torres Strait Islander people were administered a culturally themed semi-structured questionnaire in custodial settings in Victoria, Australia. The questionnaire included measures of cognitive impairment, SEWB and forensic needs. Analyses were performed to determine differences in the presence of SEWB and unmet custodial needs by level of cognitive impairment. Findings revealed a diminished level of wellbeing for cognitively impaired participants across several factors. Cognitive impairment was associated with poorer coping mechanisms, additional experiences of racism, difficulties handling emotions, discomfort around non-Aboriginal people and reduced access to meaningful activities in custody. All participants regardless of their level of impairment recognised the importance of cultural engagement; however, cognitively impaired participants had greater difficulty accessing/practicing cultural activities. Culturally responsive disability assistance should be available at all phases of the justice system for Indigenous people with cognitive impairment to ensure that equitable care is accessible and needs are addressed.

PTSD Among Aboriginal and Torres Strait Islander People in Custody in Australia: Prevalence and Correlates.

Mental disorder and trauma experiences are highly prevalent among individuals in custody; however, the impact of posttraumatic stress disorder (PTSD) on functioning is rarely considered. Indigenous Australians are incarcerated at 13 times the rate of nonindigenous Australians and report high levels of trauma exposure and psychological distress. In analysis of the largest systematic study of mental disorder among indigenous Australians in custody (N = 396), we found that the 12-month prevalence of PTSD was high in both men (12.1%) and women (32.3%). Having PTSD was also associated with high rates of co-occurring mental disorders (anxiety 31.2%, depression 32.8%, psychosis 24.6%, and substance use, 75.4%), lifetime suicidal ideation (50.1%), and suicide attempts (34.4%). Individuals with PTSD, compared to those without, were more likely to experience other mental disorders, OR = 2.42, 95% CI [1.12, 5.80], p = .022; lifetime suicide thoughts, OR = 2.43, 95% CI [1.34, 4.39], p = .001, and attempts, OR = 2.56, 95% CI [1.33, 4.83], p = .002; and high rates of intoxication at the time of arrest. Despite this, most (58.9%) had not accessed any form of mental health care prior to incarceration. These findings highlight the need to identify and manage PTSD in community and custodial populations.

Did They Ever Stand a Chance? Understanding Police Interrogations of Juveniles

The Miranda v. Arizona (1966) decision was a pivotal case in the United States. It afforded rights to suspects and defendants against self-incrimination and representation during police interrogations. Miranda ensured police read individuals in custody their rights before interrogations. However, what happens when individuals being read their rights do not fully comprehend the significance of what the police are telling them, whether it is because of lack of comprehension due to brain development, or susceptibility to the influence of those questioning them? The courts have examined these direct issues when it comes to “voluntary” confessions made by juveniles. Several cases ( J.D.B. v. North Carolina, 2011; Yarborough v. Alvarado, 2004) have tackled elements of this issue in court, but studies show that a majority of youth do not fully comprehend what they are waiving when police read their Miranda warnings. This paper will examine the decision in Miranda and other key cases related to the interrogation of juveniles, explore the cognitive development of juveniles, and investigate how police handle interrogation of juveniles.

One model of healthcare provision lessons learnt through clinical governance

Aim Clinical Governance describes a systematic approach to maintaining and improving the quality of patient care. Risk management includes a themes analysis of clinical incidents and positive interventions with the resulting information disseminated to staff through personal performance plans, and publication and development training workshops. Our model of healthcare provision utilises doctors, nurses and paramedics to assess individuals in custody and this paper discusses the implementation of clinical risk management within this setting. Method A description of the model of healthcare provision, together with a themes analysis was undertaken for all clinical incidents received by the clinical team. Each incident receives an individual response and is discussed within the clinical risk management committee. From the review of each event, learning outcomes are identified and the information captured on a database. The information is analysed for reoccurring themes and further measures are introduced to ensure a high standard of healthcare provision to all counties. Findings Of the 86,184 patient/detainee episodes from 11 county forces, from January 2009–December 2009, 159 clinical incidents and positive interventions were generated. These were categorised into C linical Near Misses – 39, P rescribing issues – 38, H ealth and Safety matters – 13, Organisational matters – 23, Positive Interventions – 21 and Professional issues – 25. Conclusion Risk management, with a regular review of clinical incidents is an essential part of clinical governance especially when working in a multidisciplinary team providing safe and effective custody healthcare. This analysis contributes to the knowledge base in clinical forensic medicine and supports the importance of identifying educational requirements for staff, working in a multiagency partnership and continuous monitoring of the quality of care for detainees.

'Coming together to share, listen and learn': A conference with a vision.

The inaugural collaborative Canadian Prison-Academic-Community Health and Education was organized by the Collaborating Centre for Prison Health and Education and supported by the University of British Columbia (UBC), Nicola Valley Institute of Technology (NVIT) and Simon Fraser University (SFU) on 4th and 5th December 2008. The conference objective was to encourage and facilitate collaborative opportunities for enhancing health, education, research, service and advocacy, for the social well-being and (re)integration of individuals in custody, their families and communities. Four conference goals were articulated: (1) To share promising practices, current evidence and scholarship in health and education related to prison populations. (2) To bring together prison, academic and community members to create collaborative opportunities for partnerships and reciprocal learning. (3) To discuss and develop policy initiatives to promote positive change within prison health and education. (4) To explore the mental, physical, emotional and spiritual aspects of prisoner health and education.