Post-release Outcomes Research Articles

Integration of Jail Booking and HIV Surveillance Data to Facilitate Care Coordination.

Many people with HIV (PWH) in jail have not been well engaged in HIV treatment in the community. This study aimed to assess the impact of a data exchange paired with care coordination for PWH on HIV outcomes after jail release. We developed an automated process to match jail booking records with HIV surveillance data. Health department HIV relinkage specialists and jail release planners used the data in weekly case conferences to facilitate care coordination for PWH who were out of care (no CD4 or viral load [VL] reported in the past 12 months) or viremic (VL ≥ 200 copies/mL) before booking. We compared VL testing within 3 months after release and viral suppression (VL < 200 copies/mL) within 6 months after release in preintervention (October 1, 2016-October 1, 2017) versus postintervention (April 1, 2018-February 1, 2019) periods using Cox proportional hazard models. Comparing 153 bookings among PWH in the preintervention period to 80 in the postintervention period, VL testing after release did not differ (47% vs. 55%; adjusted hazard ratio [aHR]: 1.05, 95% confidence interval [CI]: 0.68-1.64) nor did viral suppression (35% vs. 44%; aHR: 1.28 [95% CI: 0.80-2.05]). Data exchange and care coordination are insufficient to improve postrelease outcomes among PWH without additional interventions in the jail and community.

An initial validation of a new measure of client change in a correctional sample

ABSTRACT Ideally, when an individual enters the Criminal Justice System there is the goal and expectation that they will, over time and through intervention, change from the individual who perpetrated the crime(s) toward adopting a non-criminal identity. However, there are currently few measures of change with established validity for predicting post-program or post-release outcomes with correctional samples. The Client Change Scale [CCS; Serin & Lloyd, 2018] was developed to address this gap to provide an empirically grounded systematic measure of factors relevant for change. This study was the first to assess the psychometric properties of the CCS with post-release outcomes and to predict recidivism outcomes with a Canadian release cohort using archival data. The sample included 390 adult males under community supervision by the Correctional Service of Canada (CSC) between 2015 and 2017. Overall, the CCS reflected acceptable psychometric properties. Additionally, an exploratory factor analysis revealed that all 16 items of the CCS should be retained and provided evidence for separate but correlated consideration of internal and external change factors. These initial findings suggest the CCS has the potential to improve decision-making throughout an individual’s time in the criminal justice system by utilizing a person-centered approach in support of improving client success and subsequent public safety.

Community buprenorphine continuation post-release following extended release vs. sublingual buprenorphine during incarceration: a pilot project in Maine

BackgroundThe aim of our study was to evaluate the post-release outcomes of incarcerated individuals with opioid use disorder (OUD) treated with extended-release buprenorphine (XRB) in a rural county jail. Administrative data were collected from a pilot program within a jail in Maine that introduced XRB treatment in 2022 and a comparable jail utilizing sublingual buprenorphine (SLB) during the same period to compare post-release outcomes. Log-binomial regression models were used to estimate the risk ratio (RR) and 95% confidence interval (CI) for jail use of XRB vs. SLB on post-release community buprenorphine continuation.ResultsFrom September 2022 to September 2023, 70 individuals who received XRB were released from the pilot jail and 130 individuals who received SLB were released from the comparison jail. After adjusting for age, sex, and buprenorphine use at entry to jail, individuals released from the pilot jail were almost 3 times (adjusted RR = 2.67, 95% CI 1.84, 3.88) as likely to continue community buprenorphine treatment post-release relative to the comparison jail. In addition, utilization of XRB allowed for expanded access to OUD treatment, was well tolerated, and reduced medication diversion.ConclusionsIn this pilot program in Maine, XRB treatment during incarceration was associated with higher post-release community buprenorphine continuation when compared to individuals treated with SLB. These findings provide strong evidence for the superiority of XRB vs. SLB for the treatment of OUD in jail settings.

Higher methadone dose at time of release from prison predicts linkage to maintenance treatment for people with HIV and opioid use disorder transitioning to the community in Malaysia

BackgroundIncarcerated people with HIV and opioid-dependence often experience poor post-release outcomes in the absence of methadone maintenance treatment (MMT). In a prospective trial, we assessed the impact of methadone dose achieved within prison on linkage to MMT after release. MethodsFrom 2010 to 2014, men with HIV (N = 212) and opioid dependence before incarceration were enrolled in MMT within 6 months of release from Malaysia's largest prison and followed for 12-months post-release. As a prospective trial, allocation to MMT was at random and later by preference design (predictive nonetheless). MMT dosing was individually targeted to minimally achieve 80 mg/day. Time-to-event analyses were conducted to model linkage to MMT after release. FindingsOf the 212 participants allocated to MMT, 98 (46 %) were prescribed higher dosages (≥80 mg/day) before release. Linkage to MMT after release occurred in 77 (36 %) participants and significantly higher for those prescribed higher dosages (46% vs 28 %; p = 0.011). Factors associated with higher MMT dosages were being married, on antiretroviral therapy, longer incarceration periods, having higher levels of depression, and methadone preference compared to randomization. After controlling for other variables, being prescribed higher methadone dosage (aHR: 2.53, 95 %CI: 1.42–4.49) was the only independent predictor of linkage to methadone after release. InterpretationHigher doses of methadone prescribed before release increased the likelihood of linkage to MMT after release. Methadone dosing should be introduced into international guidelines for treatment of opioid use disorder in prisons and further post-release benefits should be explored. FundingNational Institute of Drug Abuse (NIDA).

Perceived anxiety and depression and associated factors among women inmates with a long-term sentence in Thailand.

In Thailand, the growing prevalence of mental health problems among the increasing number of adult female prisoners has emerged as a significant public health concern. However, studies on the health of women prisoners are primarily conducted in Western societies, and studies in other countries are rare. Thailand, a non-western country, is no exception to this. The objectives of this study were to assess the current levels of anxiety and depression among women drug offenders in Thailand and to identify possible associated factors. Data were collected from a sample consisting of 554 women drug offenders serving sentences of eight years or more. Stratified random sampling with proportionate stratification was employed during the data collection. The female inmates were being held in three categories of prisons: correctional institutions, central prisons, and provincial prisons. A single question was used to measure self-perceived levels of anxiety and depression: none, moderate, or substantial. Ordered logit regression was employed in the data analysis. One out of five (21.1%) of the inmates in the sample reported no perceived current anxiety and depression, 61.7% reported moderate anxiety and depression, and 17.1% reported having substantial perceived levels of anxiety and depression. It was found that chronic health conditions or disease, concerns about economic status, and feelings of shame were associated with the perceived anxiety and depression reported by the inmates. The study's findings suggest that integrated mental health services that emphasize a holistic approach that acknowledges the intersectionality of women's mental health and societal gender roles should be provided in prisons. Regular mental health screening and accessible mental health services are essential for all incarcerated women. Empowerment programs during confinement can boost self-esteem and thus lead to better post-release outcomes. The government should also implement programs to alleviate the financial burden on prisoners' households.

Six-month post-release outcomes for inmates with traumatic brain injury in supported community programming

ABSTRACT Objective: The goal of this study is to examine the effectiveness of case management services for a population of justice-involved individuals with TBI history. Methods: Two thousand three hundred and eighty-nine records from statewide behavioral health and brain injury program databases were used in two studies. Results: Participants with a reported TBI history were more likely to have experienced trauma and to have a behavioral health diagnosis relative to incarcerated persons without TBI. Six months after release, 56.8% of participants with a history of TBI were still receiving community treatment, 27.8% were not in treatment, and 3.4% had completed treatment. There was a high attrition rate; 70% of people referred for case management failed to maintain contact. Conclusions: For those that did receive services, these data suggest that it prevented an escalation of psychosocial needs. There were no differences in community participation as measured by the Mayo Portland Adaptability Index’s Participation Index (M2PI) scores (t24 = .497, p = 0.624) at intake and after 6 months of case management. This study confirms that case management confers a benefit to persons with TBI who are released from the criminal justice system. Further, recidivism rates for this vulnerable group were no different from the larger population of returning citizens.

When Prison Becomes the Devil’s Workshop: The Association Between Idleness and Post-Release Employment, Recidivism, and Mortality

The existing literature has yet to examine the system-wide effects of idleness and participation in prison-based work and programing on multiple post-release outcomes. Using a sample of more than 77,000 releases from Minnesota prisons between 2010 and 2021, we examined the relationship between participation in prison labor and programing on post-release employment, recidivism, and mortality. The findings suggest that how people spend their time in prison significantly affects their chances of finding a job, their likelihood of recidivism, and how long they live following release from prison. As involvement in work and/or programing increased, the people released from prison were more likely to find employment while also having a reduced risk for recidivism and mortality.

Post-release outcomes of lethal and non-lethal offenders: Recidivism and participation in employment or education

This study examines post-release outcomes of former prisoners convicted of severe violence. We use random intercept models to compare recidivism and participation in employment or education among Finnish offenders convicted of homicide (n = 509), attempted homicide (n = 800), or aggravated assault (n = 1714). A matching algorithm is used to adjust for observed preexisting differences among the three offender groups.Within 3 years post-release, 52% (95% CI: 48–56%) of homicide, 57% (95% CI: 54–61%) of attempted homicide, and 79% (95% CI: 77–81%) of aggravated assault offenders engaged in general recidivism. Violent recidivism rates were 27% (95% CI: 23–31%), 36% (95% CI: 33–39%) and 52% (95% CI: 49–54), respectively. At the end of the 3-year period, 24% (95% CI: 20–28%) of homicide, 20% (95% CI: 17–23) of attempted homicide, and 16% (95% CI: 14–19%) aggravated assault offenders participated in employment or education. When matched based on pre-incarceration characteristics, disparities in post-release outcomes between the offenders convicted of completed versus attempted homicide were attenuated and no longer statistically significant.Despite homicide representing the most severe form of violence and leading to substantially longer prison sentences compared to non-lethal violence, homicide offenders do not exhibit worse post-release outcomes than those convicted of attempted homicide or aggravated assault.

The Value of Conditional Release for Insanity Acquittees.

The procedures and outcomes of conditional release of insanity acquittees is a relatively neglected area of forensic psychiatric research. The release procedures vary in individual states, resulting in a wide range of approaches, from the careful selection of appropriate patients and strict monitoring in the community, to literally no mechanism for ensuring the future safety of such individuals. In North Carolina there are institutional barriers which even hinder research on the outcomes of such cases. Haroon and colleagues report on the post-release outcomes of insanity acquittees in North Carolina from 1996 to 2020. The findings of the researchers are analyzed in light of the lack of a formal post-release monitoring system in their state, contrasted with outcomes in states where a strict monitoring program is in place. Commentary is provided on the study findings, including associations between demographic, psychiatric, and criminological characteristics of insanity acquittees and release outcomes, as well as an apparent systemic bias against minority acquittees in the insanity commitment and release process in North Carolina. Further research on this important topic, from additional state jurisdictions, is recommended.

Assessing Two Decades of Insanity Acquittee Release from the North Carolina Forensic Program.

Over the past two decades, an increasing proportion of North Carolina state psychiatric hospital beds have been used to house forensic patients. Insanity acquittees occupy almost all forensic-designated beds in the state. Despite the effect insanity acquittees have on state hospital use in North Carolina, outcomes for acquittees after they are released from the state hospital are unknown because of a lack of previous research. This study evaluates postrelease outcomes for insanity acquittees discharged from the North Carolina Forensic Treatment Program between 1996 and 2020. The study also describes the association between the demographic, psychiatric, and criminological characteristics of insanity acquittees and outcomes of recidivism or rehospitalization. The results show that insanity acquittees in North Carolina have higher rates of criminal recidivism than acquittees in other states. There is also evidence of systemic bias against minority race acquittees in the insanity commitment and release process in North Carolina. Outcomes for insanity acquittees released from the state Forensic Treatment Program could be improved through the introduction of evidence-based practices widely used in other states.

Outcomes for an arboreal folivore after rehabilitation and implications for management

Wildlife rehabilitation is a critical part of animal welfare that contributes to species conservation. Despite the resources that go into rehabilitation, how animals fare after release from care is unknown. This is particularly true for cryptic arboreal species where specialist diets in care and low detectability in the wild present challenges for both care and post-release monitoring. We evaluated post-release outcomes for koalas and assessed if koalas were fed appropriately while in care. We monitored 36 koalas that had experienced one of three categories of medical intervention (none, minor, major) during rehabilitation. We examined the drivers of (i) koala survival and (ii) movements post-release, and (iii) evaluated variation between the species of browse fed in care versus browse selected by koalas in-situ. Overall, the post release survival rate of koalas was 58.5%, with only koalas that received medical intervention experiencing mortality. A critical threshold for mortality occurred at two weeks post-release and mortality was related to the measurable indicators of low body condition and poor climbing ability at time of release. In the month following their release, animals translocated furthest from their capture point moved the furthest. There was poor overlap between the tree species that koalas were fed in care and those they utilized post-release. We provide recommendations to address critical gaps in rehabilitation practices, as well as priorities for monitoring animals post-release to improve outcomes for arboreal folivores.

Medications for opioid use disorder during incarceration and post-release outcomes

BackgroundContinuation or initiation of MOUDs during incarceration could improve post-release outcomes by preventing return to opioid use and reducing risk of overdose. People with OUD involved in the criminal legal system are a vulnerable population, yet little research has comprehensively examined post-release outcomes associated with receiving MOUDs in jail and prison settings.MethodsThe authors conducted a review of published peer-reviewed literature on post-release outcomes associated with the use of MOUDs in correctional settings to determine implications for further research and policy.ResultsResults showed compelling evidence supporting the use of MOUDs for currently incarcerated populations, with almost all studies showing that MOUDs provided during incarceration increased community-based treatment engagement post-release. There is also evidence that initiating or continuing MOUDs during incarceration is associated with decreased opioid use and overdoses post-release, without increasing criminal involvement.ConclusionsFindings indicate that forcing tapering and withdrawal during incarceration can have dire consequences upon release into the community. Initiating or continuing MOUDs during incarceration reduces the risk for opioid use and overdose upon release by maintaining opioid tolerance and increasing community treatment engagement.

Factors associated with successful reintegration for male offenders: a systematic narrative review with implicit causal model

ObjectivesThis systematic review explored factors associated with successful reintegration into the community for male offenders and investigated which factors may be causally related to reintegration.MethodsDatabase searches were conducted in November 2021; a narrative synthesis and associated causal model with directed acyclic graph (DAG) was used to analyse the factors of reintegration.ResultsThirty-four studies met the inclusion criteria. Risk-Need-Responsivity–based interventions had the strongest evidence for reducing post-release offending. Fourteen good-quality studies met the inclusion criteria. The DAG shows six exposure variables (prison visits, witnessing victimisation, recovery perception, risk assessment, in-prison treatment, and pre-prison health) which link to several post-release outcomes (criminal justice outcomes, drug use, mental health, housing, and reintegration barriers) and confounding variables (demographics, offending history, prior reintegration barriers, substance misuse and attitudes).ConclusionsThe review identified factors that may be causally related to reintegration for male offenders and warrant further empirical investigation.

Responses to environmental enrichment are associated with personality characteristics in chestnut-bellied seed finches (Sporophila angolensis)

Environmental enrichment (EE) is used to promote natural behaviours in captive animals and may hold promise as a form of pre-release training, a strategy for improving coping skills of translocated birds. We investigated the use of EE to enhance foraging and vigilance behaviours of captive Sporophila angolensis, which may be related to post-release survival. We also evaluated whether consistent individual behavioural differences affected birds’ responses to EE. We submitted 19 captive seed-finches to three short-term challenges: tonic immobility (TI), new environment (NE) and new object (NO) tests. TI behaviour is related to fear/escape response to potential predators and novelty tests (NE and NO) assess neophobia, which are ecologically relevant personality traits influencing the shyness-boldness continuum. We noted a pronounced variability among the individuals’ personality traits, both in their fear and escape-related responses in the TI test and along shy/bold z-scores in NE and NO tests. During a period of enrichment, birds spent more time foraging and less time in vigilance states compared with both control phases. Personality traits of the birds affected their responses to enrichment with bolder birds spending more time foraging. The EE-related decrease in vigilance was independent of the birds’ personality traits. Our findings highlight interactions between personality and rearing environment that may impact post-release outcomes for translocated animals.

Communication of post-release plans in crowdfunding development initiatives: A signaling perspective

Significant research explores how developers leverage crowdfunding to attract finance for releasing digital goods. However, researchers seldom study “post-release activities” that are crucial for maintaining and advancing those goods. This article elaborates on the challenging nature of post-release activities for crowdfunding initiatives, asking how developers communicate their post-release plans to effectively prepare backers for possible changes. Using a grounded approach that connects the longitudinal history of fundraising to development to post-release, I examine initiatives that achieved impressive fundraising and development results yet varied significantly in their post-release outcomes. While they consistently signaled post-release plans, the differences are the signals’ costs, backers' reactions, and the post-release activities and outcomes. I present theoretical propositions that (1) developers benefit in the long run by combining high-cost signaling with engaging backers in follow-up conversations about post-release issues and (2) prospective backers can utilize developers' communication to identify their post-release signals. Unlike dominant research findings about signals’ impacts on mobilizing resources during fundraising, the findings emphasize signals’ post-release consequences for stakeholders. While different signaling approaches can enhance short-term performance, they also seed contrasting longer-term outcomes for developers, backers, and the industry. These findings advance knowledge on effective strategies for engaging society to build sustainable digital goods.

Revisiting the 4 R’s: Improving post-release outcomes for rescued mammalian wildlife by fostering behavioral competence during rehabilitation

Rescue, rehabilitation, and release (‘rescue-rehab-release’) of wildlife is an increasingly widespread practice across ecosystems, largely driven by habitat loss, wildlife exploitation and a changing climate. Despite this, its conservation value has not been realized, in part due to the scarcity of what has been termed “the 4th R”, research. Similar to conservation breeding and headstarting, rescue and rehabilitation entails close association of humans and the wildlife in their care over impressionable and extended periods. However, unlike these interventions, rescue and rehabilitation require an initial, and sometimes sustained, focus on crisis management and veterinary needs which can impede the development of natural behaviors and promote habituation to humans, both of which can compromise post-release survival and recruitment. In this perspective, we discuss the pathways toward, and implications of, behavioral incompetence and highlight opportunities for testable interventions to curtail negative outcomes post-release, without compromising the health or welfare of rescued individuals. We propose that practitioners ‘switch gears’ from triage to fostering behavioral competence as early in the rehabilitation process as is possible, and that research be implemented in order to develop an evidence-base for best practices that can be shared amongst practitioners. We focus on four mammalian species to illustrate specific contexts and considerations for fostering behavioral competence by building on research in the conservation translocation literature. Finally, we discuss a way forward that calls for greater cross-pollination among translocation scenarios involving extended time under human care during developmentally sensitive periods.

Incarcerated Men’s Perceptions of the Prison Environment: An Exploratory Study

The punitiveness of prisons is considered necessary for deterrence, but there is also a societal expectation that prisons will also rehabilitate. Scholars have examined whether prisons are ideal environments for rehabilitation from the perspective of the inmate, though this work largely focuses on measurement issues related to the scales used to measure offenders’ perceptions. The current research expands upon this by asking a sample of 154 incarcerated men from three different correctional facilities in the Midwestern United States what they think about their current correctional environment using the Prison Environment Scale (PES) and focusing on the answers provided by those incarcerated individuals. These results are presented descriptively, giving a voice to the incarcerated and their perceptions of the prison environment. Results from this exploratory study indicate incarcerated individuals feel negatively about the social and physical environment of prisons, noting the existence of hierarchies, possessions being used as currency, lack of physical space, and the lack of meaningful activities. Devising ways to promote a prosocial prison environment is important for effective rehabilitation, improved institutional conduct, and positive post-release outcomes.

Characteristics, institutional behaviour, and post-release outcomes of federal Veteran and non-Veteran men offenders

LAY SUMMARY Incarcerated Veterans represent 2.5% of the federal offender population and are a unique subset of the general Canadian Veteran population. This study provides the first in-depth examination of Veteran offenders in federal custody. During the study period, 374 federal offenders self-reported as Veterans. Federal Veteran offenders were older and more likely to have committed a violent offence and to have mental health concerns. Although they were more likely to report mental health concerns, Veteran offenders have more stable institutional behaviour and greater post-release success than non-Veterans. Understanding the unique characteristics and correctional experiences of federal Veteran offenders aids in identifying needs related to intervention and support to promote successful community reintegration after release. Future qualitative research should enhance knowledge of the lived experiences of Veterans involved in the federal criminal justice system in Canada.

Rates and predictors of breach, revocation and hospital readmission of conditionally released Forensic Patients in New South Wales, Australia

ABSTRACT Forensic patients who have been referred for secure hospital care after serious offences committed whilst mentally ill often have complex mental health conditions and risks that must be carefully considered in planning their safe release into the community. This study aimed to establish the rates and predictors of several post-release outcomes in a cohort of conditionally released forensic patients in NSW, including breaches of conditions, revocation of conditional release and readmission to hospital. Among the 245 patients who were conditionally released during the study period, just over half (57.1%; n = 140) had at least one recorded breach, revocation or readmission. Independent predictors of those outcomes included not being engaged in employment or study at the time of the index offence, having a comorbid diagnosis of substance use disorder, history of head injury and having a non-homicide-related index offence. These findings have implications for post-release planning and interventions provided by forensic mental health services.

Predicting Violent Reoffending in Individuals Released From Prison in a Lower-Middle-Income Country: A Validation of OxRec in Tajikistan.

BackgroundAlthough around 70% of the world's prison population live in low- and middle-income countries (LMICs), risk assessment tools for criminal recidivism have been developed and validated in high-income countries (HICs). Validating such tools in LMIC settings is important for the risk management of people released from prison, development of evidence-based intervention programmes, and effective allocation of limited resources.MethodsWe aimed to externally validate a scalable risk assessment tool, the Oxford Risk of Recidivism (OxRec) tool, which was developed in Sweden, using data from a cohort of people released from prisons in Tajikistan. Data were collected from interviews (for predictors) and criminal records (for some predictors and main outcomes). Individuals were first interviewed in prison and then followed up over a 1-year period for post-release violent reoffending outcomes. We assessed the predictive performance of OxRec by testing discrimination (area under the receiver operating characteristic curve; AUC) and calibration (calibration statistics and plots). In addition, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for different predetermined risk thresholds.ResultsThe cohort included 970 individuals released from prison. During the 12-month follow-up, 144 (15%) were reincarcerated for violent crimes. The original model performed well. The discriminative ability of OxRec Tajikistan was good (AUC = 0.70; 95% CI 0.66–0.75). The calibration plot suggested an underestimation of observed risk probabilities. However, after recalibration, model performance was improved (Brier score = 0.12; calibration in the large was 1.09). At a selected risk threshold of 15%, the tool had a sensitivity of 60%, specificity of 65%, PPV 23% and NPV 90%. In addition, OxRec was feasible to use, despite challenges to risk prediction in LMICs.ConclusionIn an external validation in a LMIC, the OxRec tool demonstrated good performance in multiple measures. OxRec could be used in Tajikistan to help prioritize interventions for people who are at high-risk of violent reoffending after incarceration and screen out others who are at lower risk of violent reoffending. The use of validated risk assessment tools in LMICs could improve risk stratification and inform the development of future interventions tailored at modifiable risk factors for recidivism, such as substance use and mental health problems.