Post-prison Release Research Articles

Traumatic brain injury and mental health outcomes among recently incarcerated men.

This study examined the association between experiencing a traumatic brain injury (TBI) before or during incarceration and several postrelease negative mental health consequences in a cohort of men recently released from prison. The goal of the study was to explicate the variety of mental health-related issues incurring a TBI has on one's ability to successfully reintegrate back into society following incarceration. Using data from the LoneStar Project, we used ordinary least squares regression and logistic regression to assess the prevalence of depressive symptoms, stress, trauma flashbacks, and psychosis in a representative sample of men released from Texas prisons (N = 498) approximately 9 months post-prison release. Recently released men with a history of head injury exhibited higher levels of depression, B = 0.204, 95% CI [.071, .337]; stress, B = 0.266, 95% CI [.116, .416]; experiencing trauma-related flashbacks, odds ratio (OR) = 2.950, 95% CI [1.740, 5.001]; and psychosis, OR = 3.093, 95% CI [1.601, 5.975], compared to their non-head-injured counterparts. TBIs-whether sustained before or during incarceration-pose significant risks for adverse mental health outcomes, particularly for recently released individuals during the already challenging and strained period of reintegration.

Does in-prison physical and mental health impact recidivism?

Incarceration is definitively linked to poor health, and upon release from prison, many individuals experience difficulty in maintaining good health. Given the complexity of the reentry process, one's health status, both in and out of prison, likely influences additional aspects of reentry, such as abstaining from crime or adhering to parole terms. The purpose of this study is to determine whether in-prison physical and mental health, as well as changes to an individual's health upon release from prison, are related to the likelihood of recidivating. We employ the Serious and Violent Reentry Initiative (SVORI) data, a multi-state sample of formerly incarcerated males who are followed from prison to release into the community and interviewed about a number of post-prison release issues, including health. We use hierarchical logistic and multinomial regressions, where survey waves are nested within people, to assess if in-prison physical and mental health and post-release changes to health are associated with recidivism in two ways: general re-incarceration and re-incarceration due to either a technical violation of parole or a new conviction. With right-censoring due to recidivism or failure, our final sample size is 2180 person-periods (i.e., waves) nested within 871 respondents. We find that better physical health, both in-prison and changes in health post-release, is related to a higher likelihood of recidivating. Better mental health, both in-prison and changes to mental health post-release, is related to a decrease in the likelihood of recidivating. Individuals with poor mental health in-prison who make significant improvements after release see the largest reduction in their odds of recidivating. Finally, the combination of better mental health in-prison and increases in mental health post-release is associated with reductions in the likelihood of re-offending for both technical violations and new convictions. In sum, in-prison health continues to influence individuals after prison and is associated with their odds of recidivating, thus contributing to the churning of individuals through the prison system.

Desisting from Crime: In-Prison Behaviour and Cognition as Predictors of Post-Release Success

To test the possibility that in-prison behaviour and cognition provide information useful in predicting future desistance from crime, two in-prison variables and nine pre-prison and demographic control variables were correlated with post-prison release success in a group of 1,101 male inmates released from federal prison. A Cox regression proportional hazards survival analysis revealed that fewer disciplinary infractions and lower criminal thinking predicted future desistance, as measured by the absence of post-release arrests or a longer time until first arrest for those who were arrested, net the effects of the pre-prison variables and demographic measures. When disciplinary infractions were subclassified as aggressive (fighting, assault, threatening) or non-aggressive (disobedience, theft, use of intoxicants), only the non-aggressive category achieved significance. Likewise, when criminal thinking was subdivided into proactive and reactive criminal thinking, only the reactive dimension achieved significance. These findings suggest that behaviour and cognition assessed in prison may have value both in predicting desistance upon a person’s release from prison and in clarifying the nature of post-prison release success.

Does in-prison physical and mental health impact recidivism?

Incarceration is definitively linked to poor health, and upon release from prison, many individuals experience difficulty in maintaining good health. Given the complexity of the reentry process, one's health status, both in and out of prison, likely influences additional aspects of reentry, such as abstaining from crime or adhering to parole terms. The purpose of this study is to determine whether in-prison physical and mental health, as well as changes to an individual's health upon release from prison, are related to the likelihood of recidivating. We employ the Serious and Violent Reentry Initiative (SVORI) data, a multi-state sample of formerly incarcerated males who are followed from prison to release into the community and interviewed about a number of post-prison release issues, including health. We use hierarchical logistic and multinomial regressions, where survey waves are nested within people, to assess if in-prison physical and mental health and post-release changes to health are associated with recidivism in two ways: general re-incarceration and re-incarceration due to either a technical violation of parole or a new conviction. With right-censoring due to recidivism or “failure,” our final sample size is 2180 person-periods (i.e., waves) nested within 871 respondents. We find that better physical health, both in-prison and changes in health post-release, is related to a higher likelihood of recidivating. Better mental health, both in-prison and changes to mental health post-release, is related to a decrease in the likelihood of recidivating. Individuals with poor mental health in-prison who make significant improvements after release see the largest reduction in their odds of recidivating. Finally, the combination of better mental health in-prison and increases in mental health post-release is associated with reductions in the likelihood of re-offending for both technical violations and new convictions. In sum, in-prison health continues to influence individuals after prison and is associated with their odds of recidivating, thus contributing to the churning of individuals through the prison system.

Assessing the Impact of Restrictive Housing on Inmate Post-Release Criminal Behavior

The placement of inmates in restrictive housing (RH) units has become a staple of corrections policy in recent years. Despite its increased use, research on its continued effects is relatively rare when compared to the breadth of general correctional research. This study contributes to the literature by examining the effect placement in restrictive housing has on offender recidivism post prison release. Subjects include approximately 4000 inmates matched through Propensity Score Matching (PSM) techniques and followed 36 months post-release. The findings reveal that inmates placed in restrictive housing had elevated levels of recidivism and proportionally more new commitments for all crime types than those not placed in restrictive housing. Restrictive housing subjects also displayed shorter time to rearrest than non-RH individuals. The theoretical and policy implications of these findings are discussed.

A Comparative Study of the Therapeutic Education System for Incarcerated Substance-Abusing Offenders

Although many efficacious and cost-effective treatments have been established, very few substance-abusing offenders receive such treatment while incarcerated. This study compares the effectiveness of a computerized intervention, the Therapeutic Education System (TES), with Standard Care on measures of crime (including re-incarceration), drug use, and HIV risk behavior post prison release. Results show that TES and standard treatment were equally effective in reducing criminality, relapse to drug use, and HIV risk behavior. In prisons, where a majority of substance-using offenders do not receive treatment, identifying an equally effective high-volume alternative such as TES can greatly expand access to quality psychosocial interventions.

Prescribed contraceptives among woman after release from prison

BackgroundDespite the high rates of unintended and complicated pregnancy among women who have spent time in prison, little is known about their use of prescribed contraceptives post-prison release. We used a routinely-collected medicine utilisation dataset linked to a longitudinal cohort of adults released from prison to describe the dispensing of contraceptive medication.FindingsThe socio-demographic profiles of women in the cohort were characteristic of justice-involved populations: they were young, poorly educated, unemployed prior to incarceration, with a very high proportion identifying as Indigenous. Dispensing claims data showed that in the six months (180 days) after release from prison contraceptive medication had been dispensed to only 19 women (7.6%).ConclusionOur findings raise important questions about the reproductive health needs of women in prison and after their release. This requires urgent research and policy attention with a particular focus on the potential benefits of attending to women’s sexual and reproductive health care needs in prison in preparation for return to the community.

Aging, Incarceration, and Employment Prospects: Recommendations for Practice and Policy Reform

Aging people in prison and post-prison release pose significant yet surmountable challenges in satisfying age-specific educational, training, employment, financial and civic participation rights. This descriptive study of 677 older prisoners, aged 50+, in a statewide prison system provides a historical analysis of past and current individual and social structural level factors that influence the prisoners' economic and employment prospects after being released from prison. Results highlight the diversity within this population based on socio-demographics, work histories, family obligations, health status, and legal histories that influence the level of support experienced post incarceration. Thesefindings suggest the need for comprehensive services that provide prison and post-prison release education, vocational training, and housing and job placement for incarcerated and formerly incarcerated older adults. Strategies for providing culturally responsive tools and resources to support education, training, and employment offormerly incarcerated older adults are discussed.

Comparative effectiveness and cost-effectiveness of a computer-delivered psychosocial treatment program for prisoners with substance use disorders

Comparative effectiveness and cost-effectiveness of a computer-delivered psychosocial treatment program for prisoners with substance use disorders

The association between social stressors and drug use/hazardous drinking among former prison inmates

Social stressors are associated with relapse to substance use among people receiving addiction treatment and people with substance use risk behaviors. The relationship between social stressors and drug use/hazardous drinking in former prisoners has not been studied. We interviewed former prisoners at baseline, 1 to 3weeks post prison release, and follow up, between 2 and 9months following the baseline interview. Social stressors were characterized by unemployment, homelessness, unstable housing, problems with family, friends, and/or significant others, being single, or major symptoms of depression. Associations between baseline social stressors and follow-up drug use and hazardous drinking were analyzed using multivariable logistic regression. Problems with family, friends, and/or significant others were associated with reported drug use (AOR 3.01, 95% CI 1.18–7.67) and hazardous drinking (AOR 2.69, 95% CI 1.05–6.87) post release. Further research may determine whether interventions and policies targeting social stressors can reduce relapse among former inmates.

The Role of Sentencing Commissions in the Imposition and Enforcement of Release Conditions

Nationally, a substantial proportion of prison admissions are due to revocations of probation or post-prison release, rather than new convictions and sentences. Sentence revocations have helped fuel U.S. prison growth despite a significant decline in crime across the nation. The process for deciding who is revoked and who is not is a discretionary one that in most jurisdictions is wholly unguided by law or policy. As a result, decisions are often made haphazardly, and without regard to risk the offender poses to the community. Although many states now realize that the legal and policy problems surrounding sentence revocations are urgent and require new thinking and new solutions, there are few successful innovations upon which to build. Three changes could dramatically reduce prison admissions and incarceration rates: substituting short jail terms and day fines for probationary supervision; avoiding release conditions that aren't essential to public safety; and reducing the length of time offenders are subject to conditional release (and thus, to revocation). State sentencing commissions are well-positioned to promote these reforms, and to offer judges and correctional decision makers more guidance on the principles that should govern their revocation decisions. Doing so would conserve community supervision resources for the rehabilitation and reintegration of offenders, lessen the need for costly and often counter-productive revocation sanctions, and improve the quality of decision making at the time of sentencing and throughout the execution of the sentence.

Take-home emergency naloxone to prevent heroin overdose deaths after prison release: rationale and practicalities for the N-ALIVE randomized trial.

The naloxone investigation (N-ALIVE) randomized trial commenced in the UK in May 2012, with the preliminary phase involving 5,600 prisoners on release. The trial is investigating whether heroin overdose deaths post-prison release can be prevented by prior provision of a take-home emergency supply of naloxone. Heroin contributes disproportionately to drug deaths through opiate-induced respiratory depression. Take-home emergency naloxone is a novel preventive measure for which there have been encouraging preliminary reports from community schemes. Overdoses are usually witnessed, and drug users themselves and also family members are a vast intervention workforce who are willing to intervene, but whose responses are currently often inefficient or wrong. Approximately 10% of provided emergency naloxone is thought to be used in subsequent emergency resuscitation but, as yet, there have been no definitive studies. The period following release from prison is a time of extraordinarily high mortality, with heroin overdose deaths increased more than sevenfold in the first fortnight after release. Of prisoners with a previous history of heroin injecting who are released from prison, 1 in 200 will die of a heroin overdose within the first 4 weeks. There are major scientific and logistical challenges to assessing the impact of take-home naloxone. Even in recently released prisoners, heroin overdose death is a relatively rare event: hence, large numbers of prisoners need to enter the trial to assess whether take-home naloxone significantly reduces the overdose death rate. The commencement of pilot phase of the N-ALIVE trial is a significant step forward, with prisoners being randomly assigned either to treatment-as-usual or to treatment-as-usual plus a supply of take-home emergency naloxone. The subsequent full N-ALIVE trial (contingent on a successful pilot) will involve 56,000 prisoners on release, and will give a definitive conclusion on lives saved in real-world application. Advocates call for implementation, while naysayers raise concerns. The issue does not need more public debate; it needs good science.

At a Crossroads

The exponential increase in the number of women parolees and probationers in the last decade has made women the most rapidly growing group of offenders in the United States. The purpose of this descriptive, qualitative study is to understand the unique gendered experiences of homeless female ex-offenders, in the context of healthcare needs, types of health services sought, and gaps in order to help them achieve a smooth transition post prison release. Focus group qualitative methodology was utilized to engage 14 female ex-offenders enrolled in a residential drug treatment program in Southern California. The findings suggested that for homeless female ex-offenders, there are a myriad of healthcare challenges, knowledge deficits, and barriers to moving forward in life, which necessitates strategies to prevent relapse. These findings support the development of gender-sensitive programs for preventing or reducing drug and alcohol use, recidivism, and sexually transmitted infections among this hard-to-reach population.

Comparing the effectiveness of a computerized psychosocial treatment program (the therapeutic education system) to Prison drug treatment: Process and client outcomes

This multi-site trial, conducted among a sample of incarcerated offenders with substance use disorders housed in 10 prisons located in four States, randomly assigned 513 subjects either to therapeutic education system (TES) (n=258), or to standard care (n=255) to test the comparative effectiveness of the TES, a computerized psychosocial intervention, versus standard care, counselor-delivered group sessions. Findings indicate significant improvements for both conditions at 3- and 6-months post-prison release on measures of self-reported criminal activity, substance use, and HIV risk behaviors, but no significant group differences were evident. Although significant group differences were not present, if operated at full capacity, TES could be a lower cost long-term option. Thus, TES could improve access to quality psychosocial interventions by providing a less expensive means by which substance abuse treatment in criminal justice settings could be extended to reach the large portion of offenders whose substance use problems are typically not treated.

Postprison release HIV-risk behaviors in a randomized trial of methadone treatment for prisoners.

This secondary analysis examined the impact of methadone initiated in prison on postrelease HIV risk behaviors. The parent study was a three-group randomized clinical trial in which participants received drug abuse counseling in prison and were randomly assigned to: (1) passive referral to substance abuse treatment upon release; (2) guaranteed methadone treatment admission upon release; and (3) methadone in prison and guaranteed continuation of methadone upon release. Participants were 211 adult males with preincarceration histories of opiate dependence. The AIDS Risk Assessment was administered at baseline (in prison) and at 1-, 3-, 6-, and 12-month postrelease. Data were analyzed for the entire sample (N = 211) as well as the subsamples who reported injecting drugs in the 30 days prior to incarceration (n = 131) and who reported having unprotected sex in that time frame (n = 144) using generalized linear mixed model on an intent-to-treat basis. There were no significant changes in sex- or drug-risk by Condition over Time. There were significant Time and Condition main effects for the total sample as well as the injector subsample for drug-risk behaviors. There were no significant Condition main effects for HIV sex-risk behaviors, but there were significant Time main effects. Methadone initiated in prison or immediately postrelease is associated with reduced HIV drug-risk compared to counseling in prison without methadone and passive referral to treatment at release. Participation in several drug- and sex-risk behaviors also showed significant declines during the postrelease time periods.

A comparative longitudinal analysis of recidivism trajectories and collateral consequences for sex and non-sex offenders released since the implementation of sex offender registration and community notification

The current study examines whether the recidivism trajectories post-prison release for post-sex offender registration and community notification (SORN) sex offenders are similar to or different from the recidivism trajectories post-prison release for post-SORN non-sex offenders who are released from prison via parole. Furthermore, this study also focuses on whether or not a series of collateral consequences are experienced similarly or differently among these post-SORN sex and post-SORN non-sex offender parolees. Using random samples of 247 post-SORN sex offenders and 250 post-SORN non-sex offenders released from prison in New Jersey via parole, the results indicate that sex offender and non-sex offender trajectories are similar with the exception being that there is a higher prevalence of non-sex offenders who exhibit a high-risk trajectory. Additional results demonstrate that, although sex offenders and non-sex offenders share the experience of collateral consequences, several collateral consequences including not living with friends, living in group facilities, and residential relocation appear to differentially impact sex offenders post-prison release. Study limitations and policy implications are also discussed.

Randomized trial of a reentry modified therapeutic community for offenders with co-occurring disorders: Crime outcomes

This article describes a randomized study to determine the effectiveness of a reentry modified therapeutic community (RMTC) for offenders with co-occurring substance use and mental disorders (co-occurring disorders or COD). Men with COD, approved for community corrections placement postrelease, were recruited from nine Colorado prisons and stratified according to the type of treatment received while incarcerated (i.e., a prison modified therapeutic community [MTC] program or standard care). When released, each offender was randomly assigned either to the experimental RMTC (E-RMTC) condition (n = 71) or to the control parole supervision and case management (PSCM) condition (n = 56). An intent-to-treat analysis 12 months postprison release showed that the E-RMTC participants were significantly less likely to be reincarcerated (19% vs. 38%), with the greatest reduction in recidivism found for participants who received MTC treatment in both settings. These findings support the RMTC as a stand-alone intervention and provide initial evidence for integrated MTC programs in prison and in aftercare for offenders with COD.

Sex offenders in denial: a study into a group of forensic psychologists' attitudes regarding the corresponding impact upon risk assessment calculations and parole eligibility

A considerable proportion of convicted sex offenders maintain a stance of innocence and thus do not engage in recommended treatment programmes. As a result, such offenders are often deemed to have outstanding criminogenic needs which may negatively impact upon risk assessment procedures and parole eligibility. This paper reports on a study that aimed to investigate a group of forensic psychologists' attitudes regarding the impact of denial on risk assessment ratings as well as parole eligibility. Participants completed a confidential open-ended questionnaire. Analysis indicated that considerable variability exists among forensic psychologists in regards to their beliefs about the origins of denial and what impact such denial should have on post-prison release eligibility. In contrast, there was less disparity regarding beliefs about the percentage of innocent yet incarcerated sex offenders. This paper also reviews current understanding regarding the impact of denial on recidivism as well as upon general forensic assessments.

Modified Therapeutic Community Treatment for Offenders with Co-Occurring Disorders

This paper examines outcomes 12 months post-prison release for offenders with co-occurring disorders (n = 185) randomly assigned to either a mental health control treatment (C) or a modified therapeutic community (E). Significant between-group differences were not found for mental health measures, although improvements were observed for each group. Reductions in criminal behavior were associated more with substance use than improvements in mental health symptoms, supporting the primacy of substance abuse treatment in affecting recidivism. Additional study of this population is needed to describe the relationships among diagnostic subgroups, as well as change in substance use and in mental health symptoms.

Modified Therapeutic Community Treatment for Offenders with MICA Disorders: Substance Use Outcomes

Correctional systems nationwide have increasingly turned to therapeutic community (TC) programs for the treatment of addiction in prisons. TC treatment, with modifications, has shown considerable promise in treating offenders who have co-occurring mental and substance use disorders, a group that has a mounting prevalence in prison populations. This article reports data from a study that randomly assigned male inmates with mental illness and chemical abuse (MICA) disorders (n = 139) to either a Modified TC (MTC) or a comparison group. Analyses revealed that the MTC group had significantly greater declines in alcohol and drug use at 12-months post-prison release. Additional analysis related positive substance use outcomes to reduced contact with the justice system and self-reported criminal activity. Implications for treatment and policy are discussed.