Jail Staff Research Articles

Correlates of Staff Acceptability of a Novel Telemedicine-Delivered Medications for Opioid Use Disorder Program in a Rural Detention Center.

Opioid overdose death is significantly increased immediately following incarceration. Evidence-based medications are underutilized in rural jails and detention centers. We have reported our efforts to address this gap through telemedicine-based medications for opioid use disorder treatment (tele-MOUD) for incarcerated patients. Staff acceptance and perceptions are critically important factors in the assurance of program validation. We assessed tele-MOUD acceptability and perceptions of effectiveness and stigma in one detention center. Overall, we found that jail staff's general acceptability of the program was rather low, as was perceived effectiveness of MOUD, while stigmatizing beliefs were present. Furthermore, tele-MOUD acceptability was positively correlated with perceptions of MOUD effectiveness and negatively correlated with stigmatizing notions of MOUD (p's < 0.001). Findings suggest the need for educational interventions. Future research investigating the potential moderating effects of training on staff acceptability of jail-based tele-MOUD will support the implementation and sustainability of these life-saving programs.

Facilitators and barriers to adopting or expanding medications for opioid use disorder provision in rural Colorado jails: a qualitative analysis

BackgroundOpioid use disorder (OUD) is common among individuals who are incarcerated. However, OUD treatment services are sparse in smaller county jails found in many rural areas, which limits a healthy and supportive jail environment. This study assesses the facilitators of and barriers to medications for opioid use disorder (MOUD) adoption or expansion in rural Colorado jails. A qualitative descriptive design was implemented during the summer of 2022 using semi-structured interviews with jail staff, sheriffs, and contracted personnel. Interview questions focused on facilitators of existing MOUD services and barriers to adopting or expanding services. To identify the facilitators and barriers, data were coded using thematic analysis.ResultsSeven jails were included in the study. Representatives from each jail participated in the seven interviews, which often included multiple participants per interview. Three of the jails had established routine practices for MOUD administration. Two jails occasionally administered MOUD or had plans in place to be able to administer, while the remaining two did not offer any MOUD. While administrative support, collaborative partnerships, and jail nurses facilitated MOUD use, barriers were more prevalent, including physical space limitations, distance to services, lack of providers in the area, staffing and training issues, funding/budget issues, and perceived risk of diversion.ConclusionMaking MOUD available to people who are incarcerated is an important and timely step in enhancing the jail environment, especially in rural areas that often lack access to MOUD. As states look to require MOUD availability for people who are incarcerated, facilitators to MOUD adoption/expansion can be leveraged while strategies are needed to overcome barriers.

Screening for serious mental illness in a correctional setting.

Serious mental illness (SMI) is more common among adults in correctional settings than in the general population. No standard exists for SMI screening across correctional settings; SMI therefore often goes undetected in these facilities. Placing individuals with unidentified SMI who are incarcerated in general population cells increases their risk for self-harming behaviors, suicide, and for being victims or perpetrators of exploitation and violence. This article describes a quantitative, descriptive study conducted to evaluate the use of the Brief Jail Mental Health Screen (BJMHS) tool to screen for possible SMI among individuals in a jail setting. A total of 89 individuals who were incarcerated in one jail setting were screened either with the facility's internally developed standard medical questionnaire (SMQ) or with the BJMHS. Findings showed that 28% screened positive for possible SMI using the BJMHS as compared with only 3% using the SMQ. The BJMHS flagged a higher number of possible instances of SMI than the jail's SMQ, potentially signifying its screening superiority. Identification of SMI leads to better care for individuals who are incarcerated, and it increases safety for the individual with SMI, the greater jail population, and jail staff. Findings from this study were shared with system leadership, which has replaced other screening tools with the BJMHS in at least 250 correctional facilities throughout the US.

Research note: jail staff views of inmate medical care and fear of being at risk

ABSTRACT Correctional staff are sometimes in fear of being injured on the job. Concerns about issues relating to inmate medical care could be related to feeling at risk on the job for staff. The current study explored how perceived inmate medical care issues were related to fear of being at risk on the job among staff at a large Southern US jail. The provided survey asked about staff about their concerns of being at risk and medical views dealing with if infectious diseases are handled correctly, if quality medical care was provided to inmates, if staff responded in a timely manner, if there was a high turnover of medical staff, and if inmate privacy rates put staff at risk. In a multivariate regression analysis, a view that inmate infectious diseases are handled correctly and quality medical care is provided were significantly related to lower levels fear of being in danger from the job, while the view that inmate medical privacy rights placed staff at risk had a positive effect. Views that staff respond quickly to inmate medical needs and that there is a high level of medical staff turnover both had nonsignificant effects on fear of being at risk at work.

Diffusion of medications for opioid use disorder treatment in jail settings: a convergent mixed methods study of jail staff perspectives

BackgroundImplementation of medications for opioid use disorder (MOUD) in jails varies by facility and across states. Organizational climate, including staff attitudes toward change and exposure to education, can influence perceptions of innovations like MOUD in jails. Using a mixed methods design, we aimed to understand the association between organizational climate and jail staff perceptions of MOUD.MethodsJail staff (n = 111) who operate MOUD programs in 6 Massachusetts jails completed surveys that included the Organizational Readiness for Implementing Change (ORIC) survey. Random effects logistic regression models assessed associations between organizational climate and several outcomes of perceived MOUD efficacy, acceptability, and knowledge, while controlling for covariates. Jail staff (N = 61) participated in qualitative interviews and focus groups focused on organizational climate and knowledge diffusion, which we analyzed using inductive and deductive methods.ResultsThe results indicate that organizational change readiness on the ORIC was associated with positive perceptions of MOUD, and educational resources facilitated MOUD implementation. Greater ORIC was associated with higher perception of methadone as highly acceptable for jail populations (Odds ratio [OR] 2.3, 95% Confidence Interval [CI] 1.2 to 4.4), and high knowledge of methadone (OR 2.3, 95% CI 1.1 to 4.9), with similar magnitude of effects for buprenorphine. High levels of training for jail staff on methadone and buprenorphine were also associated with higher knowledge of these medications (Methadone: OR 7.2, 95% CI 2.2 to 23.2; Buprenorphine: OR 3.4, 95% CI 1.2 to 9.5). Qualitative results point towards the importance of organizational climate and elucidate educational strategies to improve staff perceptions of MOUD.ConclusionResults underscore the importance of organizational climate for successful implementation of jail MOUD programs and provide support for medication-specific educational resources as a facilitator of successful MOUD implementation in jail settings. Findings highlight implementation strategies that may improve jail staff perceptions of MOUD.

Using Agent-Based Modeling to Examine Risk for COVID-19 Infection in Custodial Settings.

Research on pandemics in institutional settings often assumes that all human interactions within a jail pose similar viral transmission risks. We developed an agent-based model (ABM) called Simulation Applications for Forecasting Effective Responses in Corrections (SAFER-C™) to simulate nine scenarios of possible interactions and virus transmission among incarcerated individuals and jail staff and tested this assumption. We found that resumption of high-contact activities has a greater impact on the number of infections, while out-of-cell group sizes and initial vaccination rates had lower impact. This work emphasizes the importance of understanding and modeling human interactions in confinement facilities, as well as understanding, responding to, and limiting the mechanism of viral transmission in jails. Insights from ABMs provide correctional administrators with realistic options for managing responses.

Reproductive Health Problems and Health Care Services Offered to Female Inmates of Women Jail Multan

Background: Women prisoners’ health is one of the major challenges among public health issues since the increasing incarceration rate has a direct impact on prisoners’ health status. Female prisoners often face many health issues in which most important are reproductive health problems. The prison services regarding reproductive health needs of female inmates vary in every jail. Unfortunately, in many prisons, health care services for women are still not adequate. &#x0D; Objectives: The objectives of the study are to determine the frequency of reproductive health problems of female inmates and to assess the health care services offered to female inmates of Women Jail Multan. &#x0D; Method: It was cross-sectional descriptive study in which 118 female inmates of reproductive age group were included. Data was collected through questionnaire which was entered in to computer using SPSS 20.0. Frequencies and percentages were calculated and data was presented in tables. Means, Standard Deviations and Correlation were calculated. ANOVA was applied to test significance and Chi-square test was applied. Level of significance was kept at p ≤ 0.05. &#x0D; Results: Among 118 female inmates, 33.9% were 31-40 years old, 87.3% were married and 78.0% were illiterate. The length of incarceration of 42.4% female inmates was upto 12 months. 35.0% had 1-2 children and 16.5% were living in jail with their children. Majority (92.4%) had gynecological problem and 82.2% had medical problems while 11.0% had experienced sexual violence by jail staff. Only 2 females were pregnant. 100.0% female inmates had availability of lady doctor or LHV for antenatal check-up.100.0% female inmates were provided proper diet and food supplements and the quality of food was satisfactory. &#x0D; Conclusion: Study revealed that health care services for reproductive problems including obstetric and gynecological issues was satisfactory however prevalence of gynecological issues was high. Sexual violence of female inmates faced by jail staff during imprisonment was noticed for which strict legislative measures should be taken.&#x0D;

POLA ASUH PEGAWAI LAPAS DALAM PEMBINAAN PERILAKU ANAK SESUAI SYARI'AT ISLAM PADA LPKA BANDA ACEH

Nurturing is the manner in which guardians teach youngsters, in particular as a type of parental obligation to their kids, as well as a cycle to work on kids' improvement regarding social, physical and profound. Besides, nurturing is a way for guardians to manage physical, social, instructive plans, as well as how to discuss well with kids. The motivation behind this review was to break down the nurturing style of jail staff towards encouraged kids in Class II LPKA Banda Aceh as per the appropriate Islamic regulation. The strategy utilized is a spellbinding subjective methodology. The aftereffects of the review show that jail staff at LPKA assume a significant part in the training system with the obligation of overseeing, security and wellbeing of the helped kids to improve and foster the perspectives and information on the helped youngsters so they are more engaged and deliberate to become somebody who is better and more valuable further down the road mingle. Keywords : Correctional Officer; Child Behavior; Islamic Sharia

AGING IN JAIL: CHALLENGES AND IMPROVEMENTS

Abstract The increase in incarcerated older people has created challenges in correctional facilities, including settings ranging from large prisons to smaller county jails. Aging while incarcerated brings a new dimension of difficulties for older people, and to the correctional system as a whole. The resources and environments are unsuitable for an aging population and ultimately result in greater health complications. The COVID-19 pandemic exacerbated existing challenges experienced by older adults. To further assess the issues that incarcerated older people face, researchers from UMass Boston partnered with a local jail to determine the current needs and deficiencies experienced by older men. Focus groups were conducted in person with incarcerated older men regarding their experiences, opinions on having a unit specifically for older adults, and institutional changes that occurred during the COVID-19 pandemic. Zoom interviews were also carried out with staff. These conversations suggest that older incarcerated men encounter unique conditions that challenge their well-being. Such challenges include limited access to medical care and proper diets, lack of environmental accommodations, and inadequate exercise opportunities. These challenges exacerbate the burden of being in jail and can lead to higher risks of chronic illness. As well they have potential implications for the communities to which the men are released. Older men and jail staff were receptive to creating a unit specifically for older adults as a means of remedying some of these challenges. This poster offers policy suggestions to improve correctional facilities that better align with the unique needs of incarcerated older people.

Provision of health care services related to substance use disorder in southern U.S. jails

IntroductionThe U.S. jail population has more than tripled since the 1980s, and today, one out of every three incarcerated individuals is being held in a county or city jail. Substance use disorders (SUD) are overrepresented in incarcerated populations; however, little recent research has examined the availability and quality of SUD-related health care services in jail settings. Incarcerated individuals may engage with a variety of SUD-related health care services, including: screening and withdrawal management at entry, SUD treatment or other brief health care interventions while they are being held, and overdose prevention education and reentry planning at release. MethodsWe conducted a thematic analysis of qualitative data from 34 interviews conducted with 38 personnel from a purposive sample of jails that varied in size and rurality within a five-state study area. The goals of the analyses were to: 1) describe jail health care services for SUD and barriers to service provision, 2) compare current practices to best practice recommendations, and 3) provide context by describing factors at the jail and community level that influence service provision, such as access to resources. ResultsInterviewees described wide variability in both availability and comprehensiveness of SUD-related health care services. Most adhered to federal guidance for supervising withdrawal from alcohol and benzodiazepines, but not opioids. Medication for addiction treatment was most widely available for pregnant women and rarely for other individuals. Roughly one third of the jails in our sample provided behavioral group or individual therapy with a licensed counselor and roughly one quarter offered self-help groups. Very few jails provided comprehensive re-entry planning and support. Jail staff reported specific barriers to providing each type of service, as well as limiting contextual factors. Despite observed increases in case volume, jail health care staff did not necessarily receive any additional funding or staff members. Overall, lack of investment in mental and behavioral health care contributed to recidivism and feelings of hopelessness among staff. ConclusionsThis study identified several areas where jails could improve SUD-related health care services. Many of the barriers to improvement—organizational buy-in, cost/budgeting, staffing, logistics—were not under the control of health care staff. Implementing changes will require support from local governments, jails administrators, private health care companies, and other local health care providers.

Trends in COVID-19 and influenza vaccine ordering and distribution in Massachusetts jails

Incarcerated populations are highly vulnerable to respiratory illnesses such as COVID-19 and influenza. We evaluated COVID-19 and influenza vaccine ordering and administration rates among 13 of 14 Massachusetts county jails and compared them with rates in the general population. Results showed heterogeneity in the number of vaccines ordered per incarcerated individual across institutions, with small to medium-sized jails ordering more vaccines per person. Vaccine administration in jails utilized approximately 41% of the total vaccines ordered by jails. Additionally, the study revealed disparities in vaccine brand distribution between incarcerated and non-incarcerated populations, potentially perpetuating historical health inequities in carceral settings. Considering that vaccine hesitancy among incarcerated individuals and jail staff has been identified as a significant barrier to vaccination, these findings underscore the need for equitable and comprehensive vaccine distribution strategies in carceral settings, necessitating collaboration between public health and correctional systems to ensure the health and well-being of incarcerated individuals.

Jail and treatment staff attitudes regarding MOUDs before and after an implementation intervention

Jails are often the first point of assessment after arrest. This structural position provides an early opportunity to document and treat opioid use disorder (OUD). This paper describes the findings of the Building Bridges Planning Initiative, a project which prepared jail staff and their community treatment partners for the implementation and/or expansion of the use of medications for opioid use disorder (MOUDs) in 16 different jurisdictions across the U.S. From August 2019 through April 2020, 123 staff participants from 16 different counties in the U.S. completed surveys at baseline and again at one-year follow-up for staff still engaged in the project documenting changes in knowledge about, and the perceived helpfulness of, six different MOUDs. Participants were predominantly female (61%), averaged 49 years of age (SD = 11), and worked in jail (60%). Bivariate and multivariate results suggest that respondents’ perceived knowledge of/helpfulness of all MOUDs increased from baseline to follow-up, though findings for naltrexone-based MOUDs were mixed, with only depot naltrexone demonstrating significant increases in perceived helpfulness. Findings presented here suggest that over the course of the intervention, familiarity with and attitudes about MOUDs improved among individuals working within treatment centers and individuals working within correctional facilities.

Pregnant Prisoners in Shackles

Pregnant Prisoners in Shackles

Assessing Rural-Urban Differences in Screening for Mental Health Needs Among Individuals in County Jails.

Rural jails are increasingly contributing to the overall jail population and little is known about how they differ from non-rural jails. This study compares demographic, behavioral health and criminal/legal histories of 3,797 individuals who booked into three rural jails and seven non-rural jails. In addition, the study assessed how jails identify mental illness, which was compared to an objective screening instrument (Kessler-6). Individuals in rural jails were more likely to be white, female, have a history of mental health services, misuse substances, and to recidivate. After controlling for these differences, they had 1.5 times greater odds of having a mental illness but lower odds of being identified by the jails. Individuals in rural jails have more behavioral health needs and other criminogenic risk factor and their needs are less likely to be identified by jail staff, which may result in poor connection to diversion or treatment opportunities.

Changes in knowledge, behavioural expectations, self-efficacy, and stigma after an educational campaign about early psychosis for jail correction officers.

Given a lack of interventions to identify and engage individuals with early psychosis in jail and connect them to specialty care in the community upon release, we designed a Targeted Educational Campaign (TEC) for correction officers working in jails. We report on impacts of the TEC on officers' cognitive and attitudinal outcomes. Three different cohorts of officers-totaling n=451-took part in a survey: 200 at baseline before the TEC began, 123 at 6-months into the TEC, and 128 at 12-months into the TEC. Among each cohort of officers, four constructs were measured: (1) knowledge about early psychosis; (2) self-efficacy around detecting early psychosis and referring to mental health services within the jail; (3) expectations about the benefits of detection and referral to specialty care; and (4) social distance stigma toward detainees with early psychosis. While exposure to TEC elements was as-planned in the first 6-months, exposure diminished substantially at 12-months, coinciding with increasing fatigue among correction officers due to the COVID-19 pandemic as well as serious staffing shortages. Knowledge, behavioural expectations, and self-efficacy scores improved from baseline to 6-months, with greater exposure to roll-call messages driving scores. Knowledge and behavioural expectations at 12-months were associated with having received an information post card. Social distance stigma worsened across timepoints. An educational campaign for jail staff can enhance knowledge, self-efficacy, and behavioural expectations regarding early psychosis, though only while the campaign elements are active. Further research should investigate whether or not social distance stigma or other types of stigma increase alongside improvements.

Rapidly Adapting a Multicomponent Treatment for Persons Experiencing Chronic Homelessness with Comorbid Substance Use and Mental Health Disorders During the Coronavirus Disease 2019 Pandemic

Background: People with co-occurring substance use and mental health disorders (COD) who experience chronic homelessness often have difficulty engaging in treatment and support services. During the Coronavirus Disease 2019 (COVID-19) pandemic this problem was compounded by community agencies reducing or eliminating in-person care to minimize transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study examined the rapid adaptations that were made during COVID-19 to a community-based multicomponent intervention, Maintaining Independence and Sobriety Thorough Systems Integration, Outreach and Networking (MISSION), and how these changes impacted engagement in treatment and fidelity to the intervention prior to and during the COVID-19 pandemic. Methods: Guided by the Model for Adaptation Design and Impact (MADI) framework, this mixed-methods study (1) qualitatively examines the nature of the rapid adaptations made to the MISSION model with n=4 MISSION clinical program staff and (2) quantitatively examines patterns of engagement and fidelity to the MISSION model prior to and during the pandemic among n=109 people with COD who are experiencing chronic homelessness in an urban region of Massachusetts. Results: In consultation with the MISSION developers, clinical staff made rapid innovative adaptations to MISSION. These changes, identified through the qualitative interviews, included developing safe in-person session procedures (e.g., shortening sessions, adapting group sessions to individual sessions) and strategies to engage incarcerated individuals to provide continuity of care (e.g., mailing letters and coordinating with jail staff). Despite the adaptations, adherence to the MISSION model remained consistent during COVID-19 and compared to pre-COVID-19. However, there was more adherence to the structured components of care compared to the unstructured components of care during the pandemic. Interestingly, linkages to other needed treatments and community supports increased by 522% despite the pandemic closures. Conclusions: This mixed-methods study demonstrated that a community-based multicomponent intervention for people experiencing chronic homelessness with COD can be adapted rapidly during a pandemic to help maintain COD treatment and with good fidelity, and that the MADI framework can help document those changes. Thus, these findings provide treatment settings with helpful guidance for community-based COD interventions and public health emergency preparedness.

“And Then COVID Hits”: A Qualitative Study of How Jails Adapted Services to Treat Opioid Use Disorder During COVID-19

Background: Jails in Massachusetts are among the first nationwide to provide correctional populations with medications to treat opioid use disorder (MOUD). The COVID-19 pandemic caused jails to pivot and adapt MOUD programming. We aimed to identify adaptations and barriers to MOUD access that COVID-19 exacerbated or created, and document new elements that staff wish to sustain as COVID-19 recedes. Methods: We conducted semi-structured in-depth interviews and focus groups in 2020–2021 with 29 jail staff who implement MOUD programming in two Massachusetts jails. We conducted qualitative data analysis in Atlas.ti 8 using an inductive approach. Results: Participants shared that access to MOUD among correctional populations is understood by jail staff to be an essential health service. Thus, to facilitate continued access to MOUD, both during incarceration and also at community reentry, jail staff quickly implemented changes in MOUD regulations and dosing protocols and established telehealth capacity. Despite these program adaptations, participants identified how COVID-19 increased health and social needs among correctional populations, reduced availability of community-based healthcare and recovery-supportive services, and introduced new factors that could undermine recovery. Innovations that participants wished to sustain as COVID-19 receded included telehealth capacity, smaller-sized therapeutic groups, and application of a public health approach to treat opioid use disorder among correctional populations. Conclusions: During disruptive events, jails can adapt MOUD programming to ensure access for people living in jail and upon release. Findings identify factors for understanding the outcomes of jail-based MOUD programming during COVID-19 and highlight opportunities to improve service delivery after COVID-19.

Medication for opioid use disorder treatment continuity post-release from jail: A qualitative study with community-based treatment providers.

People released from jail are at elevated opioid overdose risk. Medications for opioid use disorder (MOUD) are effective in reducing overdoses. MOUD treatment was recently mandated in seven Massachusetts jails, but little is known about barriers and facilitators to treatment continuity post-release. We aimed to assess MOUD provider perspectives on treatment continuity among people released from jail. We conducted qualitative interviews with 36 medical, supervisory, and administrative staff at MOUD programs that serve jail-referred patients. We used the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation science framework to guide development of instruments, codes, and analyses. We employed deductive and inductive coding, and a grounded theory analytical approach to identify salient themes. Inner context findings highlighted necessary adjustments among jail staff to approve MOUD treatment, especially with agonist medications that were previously considered contraband. Participants perceived that some staff within jails favored abstinence-based recovery, viewing agonists as a crutch. Bridging results highlighted the importance of inter-agency communication and coordination to ensure information transfer for seamless treatment continuity in the community post-release. Pre-release planning, release on pre-scheduled dates, medication provision to cover gaps between jail release and intake at community MOUD sites, and exchange of treatment information across agencies were viewed as paramount to success. Unexpected early releases and releases from court were viewed as barriers to treatment coordination. Outer context domains were largely tied to social determinants of health. Substantial barriers to treatment continuity included shelter, food security, employment, transportation, and insurance reactivation. Through qualitative interviews with community-based MOUD staff, we identified salient barriers and facilitators to treatment continuity post-release from jails. Findings point to needed investments in care coordination, staffing, and funding to strengthen jail-to-community-based MOUD treatment, removing barriers to continuity, and decreasing opioid overdose deaths during this high-risk transition.

Jail-based reentry programming to support continued treatment with medications for opioid use disorder: Qualitative perspectives and experiences among jail staff in Massachusetts.

Individuals with opioid use disorder released to communities after incarceration experience an elevated risk for overdose death. Massachusetts is the first state to mandate county jails to deliver all FDA approved medications for opioid use disorder (MOUD). The present study considered perspectives around coordination of post-release care among jail staff engaged in MOUD programs focused on coordination of care to the community. Focus groups and semi-structured interviews were conducted with 61 jail staff involved in implementation of MOUD programs. Interview guide development, and coding and analysis of qualitative data were guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Deductive and inductive approaches were used for coding and themes were organized using the EPIS. Salient themes in the inner context focused on the elements of reentry planning that influence coordination of post-release care including timing of initiation, staff knowledge about availability of MOUD in community settings, and internal collaborations. Findings on bridging factors highlighted the importance of interagency communication to follow pre-scheduled release dates and use of bridge scripts to minimize the gap in treatment during the transition. Use of navigators was an additional factor that influenced MOUD initiation and engagement in community settings. Outer context findings indicated partnerships with community providers and timely reinstatement of health insurance coverage as critical factors that influence coordination of post-release care. Coordination of MOUD post-release continuity of care requires training supporting staff in reentry planning as well as resources to enhance internal collaborations and bridging partnerships between in-jail MOUD programs and community MOUD providers. In addition, efforts to reduce systemic barriers related to unanticipated timing of release and reinstatement of health insurance coverage are needed to optimize seamless post-release care.

The implications of borderline personality features for jail inmates' institutional misconduct and treatment-seeking.

Borderline personality disorder (BPD) is common in jails and prisons. In a sample of 506 jail inmates (30% female), we examined whether BPD symptoms assessed upon incarceration predict subsequent institutional misconduct and treatment-seeking. BPD features modestly predicted occurrence (vs. nonoccurrence) of institutional misconduct. Importantly, BPD did not predict the number of institutional misconduct incidents. That is, BPD was not associated with frequent, repeated difficulties in institutional adjustment. Consistent with previous research showing a relationship between BPD and past treatment-seeking in clinical and community samples, jail inmates' BPD features significantly predicted subsequent requests for treatment. Regarding specific types of treatment, the relationship held for substance abuse programs and forensic mental health services but not for psychoeducational services or support groups. There were very few moderators of the link between BPD and subsequent institutional misconduct and treatment-seeking. Most of the observed relationships held across sex, race, and age. Findings of the study indicate that jail staff and clinicians must learn to distinguish between initial adjustment problems and frequent misconduct among inmates high in BPD to facilitate their adjustment. The study further highlights the need for BPD-relevant treatments and services in jails. (PsycInfo Database Record (c) 2022 APA, all rights reserved).