Justice Drug Abuse Treatment Studies Research Articles

Differences in intent to refer buprenorphine among community correctional and treatment staff: A set of cross-lagged models predicting efficacy beliefs and familiarity with buprenorphine for opioid use disorder.

Despite high rates of individuals with opioid use disorder, community correctional agencies underutilize medications for opioid use disorder (MOUD). Knowledge about the mechanisms which motivate correctional employees to refer buprenorphine remains underdeveloped, and differences in these patterns by employee status are unknown. This study has two objectives: (1) investigate the presence of a reciprocal relationship between familiarity with buprenorphine and efficacy beliefs among community corrections and community treatment staff and (2) identify whether this relationship differs by staff status in referral intentions. Data were used from the Criminal Justice Drug Abuse Treatment Studies 2 (CJ-DATS 2) among correctional and treatment employees (N = 873). Four models investigated whether a reciprocal relationship existed between buprenorphine familiarity and efficacy beliefs. Then, the best fitting model was used to test the influence that prior training had on future referral intention through familiarity and efficacy beliefs among the analytic sample (n = 612), by comparing two separate structural equation models (SEMs) among correctional staff and treatment staff, respectively. The fully cross-lagged model provided a significantly better fit to the data than other models ( (1) = 7.189, p < .01). The results of the multigroup SEM show that training had positive, indirect effects on future referral intentions that significantly differed between treatment and community correction staff. Findings show that training may influence correctional staff intent to refer individuals to receive buprenorphine through familiarity. Tailored training for MOUD treatment for specific staff populations may prove more beneficial than existing approaches.

Preparing for analysis: a practical guide for a critical step for procedural rigor in large-scale multisite qualitative research studies.

Despite attention to technical aspects of conducting qualitative research, few studies describe procedures for managing pre-analysis activities in large-scale multisite qualitative projects. As part of the data collection for the Criminal Justice Drug Abuse Treatment Studies, a national multisite research cooperative with nine research centers (RCs) conducted 700 semi-structured interviews to evaluate interorganizational strategies in three protocols focused on improving addiction- and health related service delivery in criminal justice settings. Guided by the research cooperative, RCs collaborated on many aspects of the qualitative data activities (e.g., codebook development and coding activities), however, pre-analysis procedures, such as organizing and managing resources, were primarily managed at the RC level. The present study examines these various practices and describes two exemplary approaches to pre-analysis, with emphasis on lessons learned and recommendations for coordinating resources, managing data, and maintaining fidelity to the study procedures for large-scale qualitative projects.

Influence of Organizational Characteristics on Success in Implementing Process Improvement Goals in Correctional Treatment Settings.

Although research indicates that organizational characteristics substantially influence the adoption and use of evidence-based practices (EBPs), there has been little empirical research on organizational factors most likely to influence successful implementation of EBPs, particularly in criminal justice settings. This study examined organizational characteristics related to the success of change teams in achieving improvements in assessment and case-planning procedures for persons leaving correctional settings and receiving community services. In this evaluation of the Organizational Process Improvement Intervention (OPII), part of the National Institute on Drug Abuse's (NIDA's) Criminal Justice Drug Abuse Treatment Studies (CJDATS) cooperative, 21 sites were randomized to an early-start or a delayed-start condition. For this analysis, data from both conditions were combined. Agencies with fewer program needs, good communication, adequate staffing levels, good supervision, positive attitude toward rehabilitation, and higher institutional capacity for change were better able to implement planned changes in assessment and case-planning procedures. Such agencies may be better candidates for implementation improvement strategies, whereas other agencies could benefit from pre-intervention efforts aimed at strengthening these characteristics before attempting to improve assessment procedures.

Building Bridges in New Jersey.

This article describes the experience and outcomes of the National Institute on Drug Abuse-funded Criminal Justice Drug Abuse Treatment Studies 2 Improving Best Practices in Assessment and Case Planning for Offenders protocol in the state of New Jersey. The protocol was designed to test the effectiveness of an Organizational Process Improvement Intervention in improving four assessment and case planning domains for drug-involved offenders in correctional settings transferring to community treatment based agencies. This article describes the protocol and the change team model process through which correctional and community agency staff collaborated to improve assessment and case planning for offenders with substance abuse problems. The primary goal of these collaborative efforts was to link information across stages of the treatment continuum to improve service coordination. Data taken from qualitative interviews with agency participants are used to illustrate the common themes that emerged relating to the intervention process, barriers to implementing developed goals, and facilitative factors that contributed to successes. The findings from the current study provide indication that organizational process improvement strategies can be implemented within a correctional setting to reduce interorganizational barriers and to facilitate improvements in the continuum of care involved in the treatment of offenders with histories of substance abuse.

Efficacy of a Process Improvement Intervention on Inmate Awareness of HIV Services: A Multi-Site Trial.

BackgroundThe prevalence of HIV among U.S. inmates is much greater than in the general population, creating public health concerns and cost issues for the criminal justice system. The HIV Services and Treatment Implementation in Corrections protocol of the NIDA funded Criminal Justice Drug Abuse Treatment Studies tested the efficacy of an organizational process improvement strategy on improving HIV services in correctional facilities.MethodsFor this paper, we analyzed efficacy of this strategy on improving inmate awareness and perceptions of HIV services. The study used a multi-site (n = 28) clustered randomized trial approach. Facilities randomized to the experimental condition used a coach-driven local change team approach to improve HIV services at their facility. Facilities in the control condition were given a directive to improve HIV services on their own. Surveys about awareness and perceptions of HIV services were administered anonymously to inmates who were incarcerated in study facilities at baseline (n = 1253) and follow-up (n = 1048). A series of one-way ANOVAs were run to test whether there were differences between inmates in the experimental and control facilities at baseline and follow-up.ResultsDifferences were observed at baseline, with the experimental group having significantly lower scores than the control group on key variables. But, at post-test, following the intervention, these differences were no longer significant.ConclusionsTaken in context of the findings from the main study, these results suggest that the change team approach to improving HIV services in correctional facilities is efficacious for improving inmates’ awareness and perceptions of HIV services.Electronic supplementary materialThe online version of this article (doi:10.1186/s40352-015-0023-5) contains supplementary material, which is available to authorized users.

Improvements in Correctional HIV Services: A Case Study in Delaware.

This article describes the experience and outcomes of the National Institute on Drug Abuse-funded Criminal Justice Drug Abuse Treatment Studies HIV Services and Treatment Implementation in Corrections protocol in the state of Delaware. The protocol was designed to test the effectiveness of a change team model in improving HIV services in correctional settings. In Delaware, a team was created with representatives from correctional and community agencies to work on improving linkage to HIV care for individuals released from incarceration. The team made improvements in the entire HIV service continuum: linkage to HIV care, HIV education, and HIV testing. The experiences in Delaware and the findings from this study suggest that the use of a change team model is a viable method for making organizational change in correctional settings.

Optimizing continuity-of-care opportunities to reduce health risks: shared qualitative perspectives from CJDATS 2 research

Current Texas Christian University (TCU) research focuses on reducing risk for relapse and other health-related behaviors associated with HIV, HBV, and HCV. The WaySafe curriculum was developed for prisoners in the last phase of their substance abuse treatment before transitioning back to the community, and was designed to improve decisionmaking and recognizing and planning for risky situations. A critical next step is to shift the setting from incarceration to a community setting with probationers during the high-risk transition period after release from prison or completion of residential or intensive outpatient substance abuse treatment. Literature supports the importance of prevention programs [1] as part of the continuity-of-care for offenders and probationers in addressing some service gaps (in the continuum), which are widely recognized to reduce the likelihood of successful client outcomes [2,3]. The purpose of this presentation is to provide evidence from the recently completed second phase of the Criminal Justice Drug Abuse Treatment Studies (CJDATS 2), with insight from key stakeholders that informs the relevance of continuity-of-care and the significant role that community corrections and community-based health-care agencies fulfill in transitioning probationers from incarceration to home. These qualitative results come from two protocols conducted as part of CJDATS 2: HIV Services and Treatment Implementation in Corrections (HIV-STIC) and Medication-Assisted Treatment in Community Corrections Environments (MATICCE). The organizational-level findings reflect the opinions and views of criminal justice personnel and health-care providers—agencies in partnership with TCU in HIV-STIC and MATICCE. In CJDATS 2, stakeholders participated in an implementation research initiative, utilizing a change team strategy to identify and implement improvements to service delivery. In both HIV-STIC and MATICCE, the services delivery continuum incorporated elements of prison-based services and transition to community-based services in their respective areas. Qualitative results highlight the important contributions of community correction agencies, their direct contact to probationers, and their ability to facilitate linkages to service providers. Findings are discussed, emphasizing the importance of staff commitment and interorganizational relationships in continuity-of-care from prison to community as essential components to optimizing services to probationers.

Efficacy of a process improvement intervention on delivery of HIV services to offenders: a multisite trial.

We tested a modified Network for the Improvement of Addiction Treatment (NIATx) process improvement model to implement improved HIV services (prevention, testing, and linkage to treatment) for offenders under correctional supervision. As part of the Criminal Justice Drug Abuse Treatment Studies, Phase 2, the HIV Services and Treatment Implementation in Corrections study conducted 14 cluster-randomized trials in 2011 to 2013 at 9 US sites, where one correctional facility received training in HIV services and coaching in a modified NIATx model and the other received only HIV training. The outcome measure was the odds of successful delivery of an HIV service. The results were significant at the .05 level, and the point estimate for the odds ratio was 2.14. Although overall the results were heterogeneous, the experiments that focused on implementing HIV prevention interventions had a 95% confidence interval that exceeded the no-difference point. Our results demonstrate that a modified NIATx process improvement model can effectively implement improved rates of delivery of some types of HIV services in correctional environments.

The effect of a local change team intervention on staff attitudes towards HIV service delivery in correctional settings: a randomized trial.

The National Criminal Justice Drug Abuse Treatment Studies research program conducted cluster randomized trials to test an organizational process improvement strategy for implementing evidence-based improvements in HIV services for preventing, detecting, and/or treating HIV for individuals under correctional supervision. Nine research centers conducted cluster randomized trials in which one correctional facility used a modified Network for Improvement of Addiction Treatment (NIATx) change team approach to implementing improved HIV services and the other facility used their own approach to implement the improved HIV services. This paper examines whether the intervention increased the perceived value of HIV services among staff of correctional and community HIV organizations. Baseline and follow-up measures of the perceived acceptability, feasibility, and organizational support for implementing HIV service improvements were collected from correctional, medical, and community HIV treatment staff. Results indicated that the perceived acceptability and feasibility of implementing HIV services improved among staff in the facilities using the modified NIATx change team approach as compared to staff in the comparison facilities.

Brief screening for alcohol and drug problems among prisoners

s / Drug and Alcohol Dependence 140 (2014) e169–e251 e239 therefore be an appropriate and potentially effective cognitive rehabilitation tool in this population. Financial support: NIDA, NIMH. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.660 Abuse potential assessment of novel opioid analgesic NKTR-181: Implications for labeling and scheduling Lynn R. Webster1, S. Smith2, J. Silowsky2, K. Gogas2, A. Odinecs2, M. Eldon2, N. Abrouk2, R. Medve2, J. Henningfield3, A. Buchhalter3, E. Cone3, R. Fant3, S. Schnoll3 1 CRI Lifetree, Salt Lake City, UT, United States 2 Nektar, San Francisco, CA, United States 3 PinneyAssociates, Bethesda, MD, United States Aims: Discuss challenges to opioid development when early data suggest the possibility of less restrictive scheduling than CII. Thiswill be illustratedby initial findings forNKTR-181.NKTR-181 is a newmolecule intended to provide analgesic efficacy of prototypic mu-opioids but with reduced respiratory depression, sedation and abuse potential. Mu-opioid activity of NKTR-181 is retained in a morphinan core to which polymers are covalently bound resulting in slower and lower brain penetration upon oral or parenteral administration to animals than prototypic opioids. Morphinans are placed inSchedule II duringdevelopmentandcanonlybe rescheduled if the abuse potential assessment by FDA (during review of the New Drug Application) warrants less restrictive scheduling. This regulatorychallenge isnotunique toNKTR-181butdata concerning NKTR-181 will be included to support the commentary. Although oralNKTR-181 is readily absorbed, time course of pupil constriction lags drug plasma appearance 2–3h, consistent with a reduced rate of CNS uptake. These effects are maintained after repeat administration with no evidence of tolerance. Nonclinical studies suggest mu-opioid CNS effects are of substantially lower potency for NKTR181 compared to other opioids with mixed findings across models, e.g., NKTR-181 produced dose-related generalization similar to prototypic opioids at doses many times analgesic doses but with significantly reduced reinforcing effects. Opioid-like side-effects linked with abuse potential (e.g., “dreamy”, “sleepy”, “high”) were not reported in healthy volunteers at expected therapeutic doses with central effects no different than placebo. Conclusions: A preliminary 8-factor analysis of NKTR-181 suggests lower abuse potential than prototypic Schedule II opioids. How FDA addresses this challenge to drug development and scheduling will have implications for other drugs in development. Financial support: Nektar. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.661 Brief screening for alcohol and drug problems among prisoners Matthew Webster, Carl Leukefeld, Michele Staton-Tindall, Jamieson L. Duvall, Carrie B. Oser, Jennifer R. Havens Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States Aims: Although drug and alcohol abuse rates are high among prisoners, these problems often go undetected, which represent lost treatment opportunities. Brief, no-cost screening instruments can be used to efficiently identify individuals who could be further assessed and who may benefit from treatment. The purpose of this study is to examine the feasibility of using the Alcohol Use Disorders Identification Test (AUDIT) as a brief screener for alcohol use among prisoners and whether it can identify other drug problems. Methods: The AUDIT and the NIDA-modified Alcohol, Smoking, Substance Involvement Screening Test (NM-ASSIST) were administered to 382 prisoners in four Kentucky state prisons who were approaching release and consented to participate in NIDA Criminal Justice Drug Abuse Treatment Studies (CJDATS 2) cooperative agreement protocols. Participants were divided into two groups based on whether they screened positive (n=189) or negative (n=193) on the AUDIT. NM-ASSIST Substance Involvement (SI) scores were calculated for each of the nine drugs measured by the NM-ASSIST and compared between AUDIT groups. Results: No significant differences in age, race, or rurality for AUDIT groups were found, but the AUDIT positive group had a significantly higher percentage of males (73.0% vs. 61.5%). ANCOVAs, controlling for gender, found significantly higher SI scores (p< .05) for the AUDIT positive group for cannabis (15.0 vs. 10.3), cocaine (15.3 vs. 8.0), prescription stimulants (5.0 vs. 1.9), inhalants (0.6 vs. 0.2), sedatives (10.7 vs. 5.7), hallucinogens (1.1 vs. 0.5), and prescription opiates (15.6 vs. 11.1). No differences were found for SI scores for methamphetamine or street opioids. Conclusions: Findings suggest that prisoners who screen positive on the AUDIT have higher drug risk than those who screen negative, which suggests that the AUDIT may be an indirect screening for other substance problems. The majority of SI scores fell in the moderate risk range (4–26), suggesting that prisoners have drug risk for multiple drugs. Financial support: CJDATS 2 is funded by NIDA in collaboration with SAMSHA and DOJ. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.662 Association of the A335G polymorphism with striatal dopamine D2/3 receptor availability in healthy men and women Elise Weerts, M. McCaul, H. Kuwabara, M. Stephens, X. Xu, D. Wong, G.S. Wand Johns Hopkins University, Baltimore, MD, United

Abuse potential assessment of novel opioid analgesic NKTR-181: Implications for labeling and scheduling

s / Drug and Alcohol Dependence 140 (2014) e169–e251 e239 therefore be an appropriate and potentially effective cognitive rehabilitation tool in this population. Financial support: NIDA, NIMH. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.660 Abuse potential assessment of novel opioid analgesic NKTR-181: Implications for labeling and scheduling Lynn R. Webster1, S. Smith2, J. Silowsky2, K. Gogas2, A. Odinecs2, M. Eldon2, N. Abrouk2, R. Medve2, J. Henningfield3, A. Buchhalter3, E. Cone3, R. Fant3, S. Schnoll3 1 CRI Lifetree, Salt Lake City, UT, United States 2 Nektar, San Francisco, CA, United States 3 PinneyAssociates, Bethesda, MD, United States Aims: Discuss challenges to opioid development when early data suggest the possibility of less restrictive scheduling than CII. Thiswill be illustratedby initial findings forNKTR-181.NKTR-181 is a newmolecule intended to provide analgesic efficacy of prototypic mu-opioids but with reduced respiratory depression, sedation and abuse potential. Mu-opioid activity of NKTR-181 is retained in a morphinan core to which polymers are covalently bound resulting in slower and lower brain penetration upon oral or parenteral administration to animals than prototypic opioids. Morphinans are placed inSchedule II duringdevelopmentandcanonlybe rescheduled if the abuse potential assessment by FDA (during review of the New Drug Application) warrants less restrictive scheduling. This regulatorychallenge isnotunique toNKTR-181butdata concerning NKTR-181 will be included to support the commentary. Although oralNKTR-181 is readily absorbed, time course of pupil constriction lags drug plasma appearance 2–3h, consistent with a reduced rate of CNS uptake. These effects are maintained after repeat administration with no evidence of tolerance. Nonclinical studies suggest mu-opioid CNS effects are of substantially lower potency for NKTR181 compared to other opioids with mixed findings across models, e.g., NKTR-181 produced dose-related generalization similar to prototypic opioids at doses many times analgesic doses but with significantly reduced reinforcing effects. Opioid-like side-effects linked with abuse potential (e.g., “dreamy”, “sleepy”, “high”) were not reported in healthy volunteers at expected therapeutic doses with central effects no different than placebo. Conclusions: A preliminary 8-factor analysis of NKTR-181 suggests lower abuse potential than prototypic Schedule II opioids. How FDA addresses this challenge to drug development and scheduling will have implications for other drugs in development. Financial support: Nektar. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.661 Brief screening for alcohol and drug problems among prisoners Matthew Webster, Carl Leukefeld, Michele Staton-Tindall, Jamieson L. Duvall, Carrie B. Oser, Jennifer R. Havens Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States Aims: Although drug and alcohol abuse rates are high among prisoners, these problems often go undetected, which represent lost treatment opportunities. Brief, no-cost screening instruments can be used to efficiently identify individuals who could be further assessed and who may benefit from treatment. The purpose of this study is to examine the feasibility of using the Alcohol Use Disorders Identification Test (AUDIT) as a brief screener for alcohol use among prisoners and whether it can identify other drug problems. Methods: The AUDIT and the NIDA-modified Alcohol, Smoking, Substance Involvement Screening Test (NM-ASSIST) were administered to 382 prisoners in four Kentucky state prisons who were approaching release and consented to participate in NIDA Criminal Justice Drug Abuse Treatment Studies (CJDATS 2) cooperative agreement protocols. Participants were divided into two groups based on whether they screened positive (n=189) or negative (n=193) on the AUDIT. NM-ASSIST Substance Involvement (SI) scores were calculated for each of the nine drugs measured by the NM-ASSIST and compared between AUDIT groups. Results: No significant differences in age, race, or rurality for AUDIT groups were found, but the AUDIT positive group had a significantly higher percentage of males (73.0% vs. 61.5%). ANCOVAs, controlling for gender, found significantly higher SI scores (p< .05) for the AUDIT positive group for cannabis (15.0 vs. 10.3), cocaine (15.3 vs. 8.0), prescription stimulants (5.0 vs. 1.9), inhalants (0.6 vs. 0.2), sedatives (10.7 vs. 5.7), hallucinogens (1.1 vs. 0.5), and prescription opiates (15.6 vs. 11.1). No differences were found for SI scores for methamphetamine or street opioids. Conclusions: Findings suggest that prisoners who screen positive on the AUDIT have higher drug risk than those who screen negative, which suggests that the AUDIT may be an indirect screening for other substance problems. The majority of SI scores fell in the moderate risk range (4–26), suggesting that prisoners have drug risk for multiple drugs. Financial support: CJDATS 2 is funded by NIDA in collaboration with SAMSHA and DOJ. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.662 Association of the A335G polymorphism with striatal dopamine D2/3 receptor availability in healthy men and women Elise Weerts, M. McCaul, H. Kuwabara, M. Stephens, X. Xu, D. Wong, G.S. Wand Johns Hopkins University, Baltimore, MD, United

A cluster randomized trial of an organizational process improvement intervention for improving the assessment and case planning of offenders: a Study Protocol.

BackgroundThe Organizational Process Improvement Intervention (OPII), conducted by the NIDA-funded Criminal Justice Drug Abuse Treatment Studies consortium of nine research centers, examined an organizational intervention to improve the processes used in correctional settings to assess substance abusing offenders, develop case plans, transfer this information to community-based treatment agencies, and monitor the services provided by these community based treatment agencies.Methods/DesignA multi-site cluster randomized design was used to evaluate an inter-agency organizational process improvement intervention among dyads of correctional agencies and community based treatment agencies. Linked correctional and community based agencies were clustered among nine (9) research centers and randomly assigned to an early or delayed intervention condition. Participants included administrators, managers, and line staff from the participating agencies; some participants served on interagency change teams while other participants performed agency tasks related to offender services. A manualized organizational intervention that includes the use of external organizational coaches was applied to create and support interagency change teams that proceeded through a four-step process over a planned intervention period of 12 months. The primary outcome of the process improvement intervention was to improve processes associated with the assessment, case planning, service referral and service provision processes within the linked organizations.DiscussionProviding substance abuse offenders with coordinated treatment and access to community-based services is critical to reducing offender recidivism. Results from this study protocol will provide new and critical information on strategies and processes that improve the assessment and case planning for such offenders as they transition between correctional and community based systems and settings. Further, this study extends current knowledge of and methods for, the study of evidence-based practice adoption and implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/2194-7899-2-1) contains supplementary material, which is available to authorized users.

Improving measurement of injection drug risk behavior using item response theory

Background: Recent research highlights the multiple steps to preparing and injecting drugs and the resultant viral threats faced by drug users. This research suggests that more sensitive measurement of injection drug HIV risk behavior is required. In addition, growing evidence suggests there are gender differences in injection risk behavior. However, the potential for differential item functioning between genders has not been explored. Objectives: To explore item response theory as an improved measurement modeling technique that provides empirically justified scaling of injection risk behavior and to examine for potential gender-based differential item functioning. Methods: Data is used from three studies in the National Institute on Drug Abuse’s Criminal Justice Drug Abuse Treatment Studies. A two-parameter item response theory model was used to scale injection risk behavior and logistic regression was used to examine for differential item functioning. Results: Item fit statistics suggest that item response theory can be used to scale injection risk behavior and these models can provide more sensitive estimates of risk behavior. Additionally, gender-based differential item functioning is present in the current data. Conclusion: Improved measurement of injection risk behavior using item response theory should be encouraged as these models provide increased congruence between construct measurement and the complexity of injection-related HIV risk. Suggestions are made to further improve injection risk behavior measurement. Furthermore, results suggest direct comparisons of composite scores between males and females may be misleading and future work should account for differential item functioning before comparing levels of injection risk behavior.

Implementing drug abuse treatment services in criminal justice settings: introduction to the CJ-DATS study protocol series

BackgroundDespite a growing pipeline of effective clinical treatments, there remains a persistent research-to-practice gap in drug abuse services. Delivery of effective treatment services is especially lacking in the U.S. criminal justice system, where half of all incarcerated persons meet the need for drug abuse or dependence, yet few receive needed care. Structural, financial, philosophical and other barriers slow the pace of adoption of available evidence-based practices. These challenges led to the development of a multi-site cooperative research endeavor known as the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS), funded by the National Institute on Drug Abuse (NIDA). CJ-DATS engages university-based research teams, criminal justice agencies, and community-based treatment providers in implementation research studies to test strategies for enhancing treatment service delivery to offender populations.Methods/DesignThis Introduction reviews the mission of NIDA, the structure and goals of the CJ-DATS cooperative, and the implementation studies being conducted by the participating organizations. The component Study Protocols in this article collection are then described.DiscussionCJ-DATS applies implementation science perspectives and methods to address a vexing problem – the need to link offender populations with effective treatment for drug abuse, HIV, and other related conditions for which they are at high risk. Applying these principles to the U.S. criminal justice system is an innovative extension of lessons that have been learned in mainstream healthcare settings. This collection is offered as both an introduction to NIDA’s work in this area, as well as a window onto the challenges of conducting health services research in settings in which improving public health is not the organization’s core mission.

Policies and practices in the delivery of HIV services in correctional agencies and facilities: results from a multisite survey.

HIV risk is disproportionately high among incarcerated individuals. Corrections agencies have been slow to implement evidence-based guidelines and interventions for HIV prevention, testing, and treatment. The emerging field of implementation science focuses on organizational interventions to facilitate adoption and implementation of evidence-based practices. A survey of correctional agency partners from the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) revealed that HIV policies and practices in prevention, detection, and medical care varied widely, with some corrections agencies and facilities closely matching national guidelines and/or implementing evidence-based interventions. Others, principally attributed to limited resources, had numerous gaps in delivery of best HIV service practices. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery gaps in corrections.

Job Frustration in Substance Abuse Counselors Working With Offenders in Prisons Versus Community Settings

Substance abuse counselors who work with offenders are facing increasing caseloads, which puts them at higher risk of job frustration. The purpose of this study was to explore differences between substance abuse counselors employed in prison versus community settings in terms of level of organizational support and job frustration. This study also investigated whether organizational support was associated with job frustration after controlling for counselor characteristics and workplace setting. This was accomplished utilizing data that were collected from 267 counselors as part of the Criminal Justice Drug Abuse Treatment Studies research cooperative. Results indicated that counselors employed in community settings, as compared with those employed in prisons, are more likely to report higher levels of perceived organizational support. In addition, ordinal logistic regression results reveal that counselors who are non-White and have greater levels of organizational support have less job frustration, after controlling for counselor characteristics and workplace setting. The researches to practice implications are discussed.

Relationship Power As a Mediator of Intimate Partner Violence and Mental Health Issues Among Incarcerated, Substance-Using Women

The purpose of this study was to examine perceived relationship power as a mediator of the relationship between intimate partner violence (IPV) and mental health issues among incarcerated women with a history of substance use. Cross-sectional data from 304 women as part of the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) were used to evaluate this hypothesis. Regression analyses examined the mediation relationship of perceived relationship power in the association between a history of IPV and mental health issues. Results supported the hypothesis, suggesting that perceived relationship power helps to explain the association between IPV and mental health issues. Implications of the findings for the provision of services to address the needs of these women are discussed, including assessment of perceived relationship power and focusing counseling interventions on women's experiences with power in intimate relationships.

Criminal Justice Drug Abuse Treatment Studies (CJDATS): Improving assessment and case planning in corrections through a process improvement intervention

The goal of the Criminal Justice Drug Abuse Treatment Studies Organizational Process Improvement Intervention study is to evaluate a process improvement strategy designed to improve the assessment of prisoners, the development of case plans for community services, the transfer of this information to community treatment agencies, and the use of the case plans to provide services. Specifically, the strategy involves the use of a local change team (consisting of correctional and treatment staff) and a facilitator who conducts a structured assessment of the quality of their existing practices in four domains (measurement and instrumentation, integration with case plan, conveyance and utility, and service activation) and then identify and implement specific process improvement goals in one or more of these domains. Nine research centers and their criminal justice partners are involved in the study. The intervention is evaluated using a multi-site cluster randomized design.

Assessment in correctional institutions and community re-entry: Correspondence to best practices

Consistent with the risk–need–responsivity model (Andrews & Bonta, 1994), assessment of criminogenic risks and needs is an evidence-based practice recognized by government agencies and professional organizations. The current study describes assessment practices within correctional organizations participating in Criminal Justice Drug Abuse Treatment Studies research protocol testing the effectiveness of the Organizational Process Improvement Intervention (OPII) for improving assessment, use, and transfer of information from institutional to community programs.

Limiting options: sex ratios, incarceration rates, and sexual risk behavior among people on probation and parole.

To investigate how incarceration may affect risk of acquiring HIV and other sexually transmitted infections, we tested associations of ex-offenders' sexual risk behavior with the male-female sex ratio and the male incarceration rate. Longitudinal data from 1287 drug-involved persons on probation and parole as part of the Criminal Justice Drug Abuse Treatment Studies were matched by county of residence with population factors, and stratified by race/ethnicity and gender. Generalized estimating equations assessed associations of having unprotected sex with a partner who had HIV risk factors, and having >1 sex partner in the past month. Among non-Hispanic black men and women, low sex ratios were associated with greater risk of having unprotected sex with a risky partner (adjusted relative risk [ARR] = 1.76, 95% confidence interval [CI] = 1.29, 2.42; ARR = 2.48, 95% CI = 1.31, 4.73, respectively). Among non-Hispanic black and non-Hispanic white (NHW) women, low sex ratios were associated with having >1 sex partner (ARR = 2.00, 95% CI = 1.02, 3.94; ARR = 1.71, 95% CI = 1.06, 2.75, respectively). High incarceration rates were associated with greater risk of having a risky partner for all men (non-Hispanic black: ARR = 2.14, 95% CI = 1.39, 3.30; NHW: ARR = 1.39, 95% CI: 1.05, 1.85; Hispanic: ARR = 3.99, 95% CI = 1.55, 10.26) and having >1 partner among NHW men (ARR = 1.92, 95% CI = 1.40, 2.64). Low sex ratios and high incarceration rates may influence the number and risk characteristics of sex partners of ex-offenders. HIV-prevention policies and programs for ex-offenders could be improved by addressing structural barriers to safer sexual behavior.