Health and Justice最新文献

{"title":"Receipt of medications for opioid use disorders among veterans by race/ethnicity and legal involvement: an observational study of electronic health records.","authors":"Andrea K Finlay, Ekaterina Pivovarova, Mengfei Yu, Christine Timko, Ingrid A Binswanger, David Smelson, Emmeline Taylor, Alex H S Harris","doi":"10.1186/s40352-025-00336-6","DOIUrl":"https://doi.org/10.1186/s40352-025-00336-6","url":null,"abstract":"<p><strong>Background: </strong>The Veterans Health Administration has made strides to improve access to medications for opioid use disorder overall. However, quality improvement methods to assess treatment gaps may not sufficiently detect differences in medication access by intersecting patient factors, which may have multiplicative rather than additive effects. This study aimed to determine whether race/ethnicity and legal involvement interact in receipt of medications for opioid use disorder among Veterans Health Administration patients.</p><p><strong>Methods: </strong>Using national electronic health record data from Fiscal Years 2021-2022, we examined the receipt of medications for opioid use disorder among veterans diagnosed with opioid use disorder who received healthcare at Veterans Health Administration facilities (n = 65,883). We conducted a mixed effects multivariable logistic regression model to examine an interaction effect of race/ethnicity and legal involvement with receipt of any medications for opioid use disorder, both unadjusted and adjusted for patient and facility characteristics.</p><p><strong>Results: </strong>In an adjusted logistic regression model, the interaction effect indicated that non-Hispanic Black veterans with legal involvement had the lowest odds of medications for opioid use disorder receipt compared to non-Hispanic White veterans without legal involvement (adjusted odds ratio = 0.67, 95% confidence interval = 0.59-0.77, p <.0001). Non-Hispanic American Indian/Alaska Native patients without legal involvement (adjusted odds ratio = 0.85, 95% confidence interval = 0.73-0.99, p =.04) also had lower odds of receipt of medications for opioid use disorder compared to non-Hispanic White patients without legal involvement. Non-Hispanic White veterans with legal involvement (adjusted odds ratio = 1.07, 95% confidence interval = 1.01-1.14, p =.03) had higher odds of receipt of medications for opioid use disorder compared to non-Hispanic White patients without legal involvement.</p><p><strong>Conclusions: </strong>Veterans Health Administration quality improvement efforts should monitor interacting racial and legal status factors and understand and address patient, clinical, and regulatory barriers to medications for opioid use disorder among Black veterans with legal involvement.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"28"},"PeriodicalIF":3.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid reimbursement for community violence intervention and prevention (CVI): a multi-state policy implementation case study.","authors":"Sheetal Ranjan, C Clare Strange, Katheryne Pugliese","doi":"10.1186/s40352-025-00327-7","DOIUrl":"https://doi.org/10.1186/s40352-025-00327-7","url":null,"abstract":"<p><strong>Background: </strong>Violence has fluctuated in the United States in recent years. Additionally, policing practices have been challenged, especially in neighborhoods of color. Community Violence Intervention (CVI) programs have emerged as an effective policy to address violence through neighborhood-centered resources, trauma-informed care, and credible messengers, without full reliance on law enforcement officials. However, inconsistent funding challenges the feasibility and sustainability of these programs. In 2021 several states introduced policies to allocate Medicaid reimbursement for CVI services offering a promising solution to a more sustainable stream of funding.</p><p><strong>Methods: </strong>This study uses rigorous qualitative analysis to evaluate the implementation of Medicaid reimbursement policies in California, Illinois, and Connecticut, applying the Exploration-Preparation-Implementation-Sustainment (EPIS) model. An analysis of secondary documentation and semi-structured interviews with key stakeholders from the first three states to implement the policy. Stakeholders were recruited from a variety of policy, medical, and non-profit sectors to provide their perspectives and expertise on implementation.</p><p><strong>Results: </strong>Interviews with stakeholders from policy, medical, and non-profit sectors and a deep analysis of secondary documentation identifies key successes and barriers to effective implementation of Medicaid reimbursement policies across the United States. Acknowledging the barriers of implementation highlights where policy planning and development fails to be properly implemented on the ground. Findings emphasize the need for state-specific policy adaptation, collaboration amongst policymakers and practitioners, and sufficient training for on-the-ground CVI staff members.</p><p><strong>Conclusions: </strong>Implementation of a Medicaid reimbursement policy for CVI programs could improve the efficacy and sustainability of such programs. However, states need to be aware of the challenges that may arise during the planning and implementation phases. The findings from this study reveal that policy makers, service providers and medical professionals need to be involved and collaborative throughout the planning and implementation process of the policy. States that are planning to implement these policies should assess whether they are ready to implement the policy to ensure that it is successful in the long term.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"27"},"PeriodicalIF":3.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient perspectives of jail based MOUD treatment: views of individuals who have returned to the community following incarceration.","authors":"Claudia Santelices, Warren Ferguson, Rebecca Rottapel, Ekaterina Pivovarova, Elizabeth Evans, Thomas Stopka, Peter Friedmann","doi":"10.1186/s40352-025-00319-7","DOIUrl":"https://doi.org/10.1186/s40352-025-00319-7","url":null,"abstract":"<p><strong>Background: </strong>Massachusetts passed legislation in 2018 to mandate provision of medications for opioid use disorder (MOUD) in select jails to address the high risk of opioid overdose after release. Since 2019, we have conducted a Type-1 hybrid effectiveness-implementation study of this program. We present findings on the perspectives and experiences of persons treated in these jails.</p><p><strong>Methods: </strong>We conducted qualitative analyses of semi-structured interviews that were conducted in 2022 with 38 adults released to the community who had been treated with MOUD while living in one of eight Massachusetts jails. The Exploration, Preparation, Implementation, and Sustainment (EPIS) framework informed development of the interview guide and analysis of qualitative data. Deductive and inductive strategies were used for coding and analyses.</p><p><strong>Results: </strong>Participants were 41.5 years old; predominantly male; 84.2% white, 23.7% Hispanic/Latino and 7.9% Black; and most continued taking MOUD. Thematic analysis focused on four code reports: Perception of Addiction/MOUD, Barriers/Facilitators, Impact of MOUD in Jails, and Stigma. Participants perceived that MOUD helped to prevent relapse. Prompt and consistent access to medication, and respectful treatment by healthcare and carceral staff were highlighted as facilitators. In contrast, some participants perceived that policy-centered rather than patient-centered treatment drove timing of medication initiation or response to medication changes. Insufficient staffing and the COVID-19 pandemic contributed to treatment delays. Overall, individuals incarcerated in jails that have expanded treatment eligibility to include earlier induction with MOUD generally felt more positive about their experience than individuals reporting delayed induction.</p><p><strong>Conclusions: </strong>Participants valued the ability of jail based MOUD programs to help clients achieve recovery from OUD. Their perceptions highlight the intrinsic value of MOUD programs that promote and support wellbeing through a person-centered approach to treatment. Participants stressed that MOUD programs should be patient-centered and guided by patients' symptoms and needs.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"25"},"PeriodicalIF":3.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"You can't incarcerate yourself out of the drug problem in America:\" A qualitative examination of Colorado's 2022 Fentanyl​ criminalization law.","authors":"Katherine LeMasters, Samantha Nall, Cole Jurecka, Betsy Craft, Paul Christine, Ingrid Binswanger, Joshua Barocas","doi":"10.1186/s40352-025-00334-8","DOIUrl":"https://doi.org/10.1186/s40352-025-00334-8","url":null,"abstract":"<p><strong>Background: </strong>In response to the U.S. overdose crisis, many states have increased criminal penalties for drug possession, particularly fentanyl. This study sought to qualitatively explore diverse community perspectives on increasing criminal legal penalties in Colorado for fentanyl possession (House Bill 22-1326) and the broader role of the criminal legal system in addressing substance use and overdose prevention. We conducted 31 semi-structured interviews in 2023 with community leaders directly working with people who use drugs, individuals with lived experience with drug use and the criminal legal system, and law enforcement throughout Colorado. Interviewees were asked about the perceived impact of House Bill 22-1326 on their communities and agencies. After interviews were complete, we created templated summaries and matrix analyses to conduct rapid qualitative analysis, an action-oriented approach to qualitative data analysis.</p><p><strong>Results: </strong>Respondents included peer support specialists (n = 7), policymakers (n = 6), community behavioral health/harm reduction providers (n = 6), criminal legal program staff (n = 8), and law enforcement (n = 4), with nine participants from rural counties. Analysis revealed that participants found increasing criminal penalties for fentanyl possession to be misguided: \"And the felony [of HB-1326] is such a good example of a policy being led by feelings rather than evidence.\" This was in the context of participants' divergent views on police as conduits to treatment and punishment and perceiving jail as an (in)appropriate response for substance use disorder treatment.</p><p><strong>Conclusions: </strong>All participants supported policy efforts to prevent fatal fentanyl overdoses, yet, most thought that increased use of police and incarceration as avenues to prevent overdose was misguided. This study highlights a diverse array of community perspectives that can inform policy decisions concerning criminal penalties for fentanyl possession and distribution and can inform policies that affect people who use drugs broadly.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"26"},"PeriodicalIF":3.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cost of implementing and sustaining an evidence-based, behavioral-health electronic screening system in probation departments.","authors":"Techna Cadet, Katherine S Elkington, Margaret Ryan, Ali Jalali, Gail A Wasserman, Faye S Taxman, Michael L Dennis, Sean M Murphy","doi":"10.1186/s40352-024-00312-6","DOIUrl":"10.1186/s40352-024-00312-6","url":null,"abstract":"<p><strong>Background: </strong>Roughly 50%-75% of youths who have had contact with the juvenile justice system have a mental-health disorder. In 2019, a northeastern state required probation departments to implement an evidence-based behavioral health (BH) screen. e-Connect is a digital clinical decisional support system designed to identify suicide thoughts and behaviors and related BH risk and triage youths based on BH need, then facilitate linkage to care.</p><p><strong>Objective: </strong>To identify the resources and estimate the costs required to implement and sustain e-Connect from probation-department and policymaker perspectives.</p><p><strong>Methods: </strong>Prospective micro-costing analysis conducted concurrently with a rigorous evaluation of e-Connect. Data were collected for 622 youths ages 10-18 via administrative records, study instruments, and semi-structured interviews. Resources/costs were categorized as \"fixed\", \"time-dependent\", or \"variable\". Mean annual costs (per-county and per-screen, by county) were calculated for two intervention phases, \"implementation\" and \"sustainment\". All costs are in 2019 USD.</p><p><strong>Results: </strong>The policymaker-relevant, annualized, mean, per-county start-up and sustainment costs were $18,704 (SD = $14,320) and $13,374 (SD = $13,317), respectively. The per-screen sustainment cost was $115 (SD = $113) across counties, with variation attributed to a combination of a county's behavioral-health needs, and differences in the types of resources utilized as part of their post-screening clinical response.</p><p><strong>Conclusion: </strong>The results of this analysis will inform the decisions of probation departments and their stakeholders, who are interested in implementing an evidence-based behavioral-health screen for youths on probation. Site-level figures will provide important details regarding the resources/costs associated with various implementation and management strategies. Cross-site, per-person averages will provide crucial inputs into budget impact models and cost-effectiveness analyses.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"24"},"PeriodicalIF":3.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linkages between incarceration and health for older adults.","authors":"Meghan A Novisky, Stephanie Grace Prost, Benjamin Fleury-Steiner, Alexander Testa","doi":"10.1186/s40352-025-00331-x","DOIUrl":"https://doi.org/10.1186/s40352-025-00331-x","url":null,"abstract":"<p><p>The aging population in United States (US) correctional facilities has grown dramatically over the last several decades. At present, roughly one in four adults incarcerated in US prisons are at least 50 years of age. Research over the last ten years has likewise expanded to catalog the impacts of incarceration on older adults, and the myriad ways incarceration is unique for this population. In this paper, we summarize the state of the literature at the intersection of incarceration, health, and aging. We begin by outlining the impacts of incarceration on a range of individual health outcomes for older adults. Next, we offer targeted policy implications to address the health consequences of incarceration for older adults. Finally, we conclude by offering a research agenda that emphasizes theory building, jail-based approaches, and expansion of what is known about older women, cognitive impairment, correctional staff perspectives, and interventions to enhance the health of older persons who are incarcerated.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"23"},"PeriodicalIF":3.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors contributing to the expansion of medication for opioid use disorder (MOUD) within the New Hampshire Department of Corrections (NHDOC).","authors":"Nancy Clayman, Pracha Eamranond, Helen Hanks, Michael Mitcheff, Lisa RappaMannion, Diane York, Paula Mattis, Heidi Guinen, Alex Carp, Laura Olson, Kathleen Bell, Lydia Shahi, Elizabeth Saunders, Joshua Lee, Lisa Marsch","doi":"10.1186/s40352-025-00333-9","DOIUrl":"10.1186/s40352-025-00333-9","url":null,"abstract":"<p><strong>Introduction: </strong>Expanding access to medication for opioid use disorder (MOUD) to people involved in the carceral system is a priority for the New Hampshire Department of Corrections (NHDOC), where more than 40% of residents have an opioid use disorder (OUD). NHDOC participated in the multi-site Justice Community Opioid Innovation Network (JCOIN) clinical trial, \"Long-acting buprenorphine vs. naltrexone opioid treatments in criminal justice system-involved adults (EXIT-CJS)\". We examine the contributing factors to the expansion of the NHDOC MOUD program from 2021 to 2023, including participation in EXIT-CJS, which occurred from 2019 to 2024.</p><p><strong>Methods: </strong>Data on quarterly MOUD prescribing and EXIT-CJS enrollments were abstracted from the NHDOC medical records from July 1, 2021- December 31, 2023 as part of a quality improvement initiative. To examine factors influencing expansion of the program, conversations were conducted with NHDOC leadership team and clinical staff.</p><p><strong>Results: </strong>From 2021 to 2023, the quarterly number of patients treated with MOUD at the NHDOC increased by more than 400% from a total of 165 patients in July-September 2021, to 685 patients in October-December 2023. At the policy level, elimination of the federal DATA-Waiver (X-Waiver) Program allowed additional providers to prescribe MOUD. At the organizational level, support from NHDOC leadership, including Medical and Forensics and the Commissioner's Office, encouraged broader engagement in MOUD from providers, multidisciplinary staff, and security. This work was augmented through receipt of State Opioid Response (SOR) dollars with a requirement to continue to advance education for NHDOC staff on the efficacy of MOUD. Resulting discussions between medical providers, experts on addiction treatment, staff and residents supported a culture change in attitudes about MOUD. During this same time window, the NHDOC made significant adjustments in the distribution of MOUD by adjusting the nursing administration process thus reducing the stigma associated with being a patient on MOUD and treating MOUD medication administration like all other medical conditions.</p><p><strong>Discussion: </strong>Policy-related, organizational, and individual factors contributed to the expansion of the MOUD program at the NHDOC. EXIT-CJS recruitment occurred synergistically with the expansion of the MOUD program. As NHDOC was engaged as a site in EXIT-CJS, study recruitment increased awareness of extended-release treatment options among residents and staff.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"22"},"PeriodicalIF":3.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Equipping and enabling\" health literacy during a \"time of change\": understanding health literacy and organisational health literacy responsiveness for people leaving prison in later life.","authors":"Ye In Jane Hwang, Amanuel Kidane Hagos, Ben Harris-Roxas, Adrienne Lee Withall, Tony Gerard Butler, Stephen Hampton, Christina Cheng, Shandell Elmer","doi":"10.1186/s40352-025-00328-6","DOIUrl":"10.1186/s40352-025-00328-6","url":null,"abstract":"<p><strong>Background: </strong>This qualitative study investigated experiences and understandings of health literacy for those released from prison in later life. The global rise in older incarcerated individuals-defined as those aged 50 and above-poses significant public health and health equity challenges. With up to one in four prisoners being categorized as \"older,\" their complex health needs often exceed those of younger inmates and the general community. An important but under-investigated challenge for this older population is navigating health care systems and self-management of health after release. Research evidence, albeit limited, has consistently identified health literacy deficits in this this population, complicating their health outcomes and reintegration more generally. This study fills a gap in the experience of health literacy for older people leaving prison, thus contributing to conceptual understandings and guiding targeted intervention development for this marginalised population.</p><p><strong>Results: </strong>Fifteen people with lived experience of release from prison in older age (mean age = 57) and thirteen staff or stakeholders with relevant professional experience from Australia participated in workshops and interviews exploring health literacy during the post-release period. An abductive thematic analysis was applied to the data, guided by the concept of health literacy and organisational health literacy responsiveness. The analysis produced two global themes (\"Change\" and \"Equipped and Enabled\") and seven subthemes (\"A demanding time of change\", \"Braving a new world\", \"Leaving prison care\", \"I can only do what I can\", \"Help me help myself\", \"Others are key\", \"Everybody's problem, nobody's job\"). Together, these themes indicated these individuals are the subject of complex and overlapping life circumstances, with limited resources and support currently available for health literacy both during and after release.</p><p><strong>Conclusion: </strong>This population are mostly passive health care and information 'receivers' as a result of their imprisonment, who must be equipped and enabled to become more active health literacy 'doers'. This can be achieved through interventions that prepare the person better for life in community, and improve positive self-concept. Health and custodial organisations have an important role to play, with opportunities for improvement apparent across areas such as communication, focused health literacy policies, and collaboration with community partners.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"21"},"PeriodicalIF":3.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of contextually specific support relationships in implementing programs to link people to medication for opioid use disorder (MOUD) treatment during reentry from county jails.","authors":"Margaret McGladrey, Marisa Booty, Susannah Stitzer, Hannah K Knudsen, Sharon L Walsh, Michael Goetz, Hallie Mattingly, Michelle Lofwall, Laura Fanucchi, Devin Oller, Amanda Fallin-Bennett, Carrie B Oser","doi":"10.1186/s40352-025-00330-y","DOIUrl":"10.1186/s40352-025-00330-y","url":null,"abstract":"<p><strong>Background: </strong>This study uses the Practical, Robust, Implementation, and Sustainability Model (PRISM) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to describe how features of jail contexts are associated with the number of people linked to medication for opioid use disorder (MOUD) and sustainment of jail linkage programs implemented in Wave 1 of the HEALing Communities Study in Kentucky (HCS-KY) from 2021 to 22. The HCS-KY is part of a parallel-group, cluster-randomized wait-list controlled trial examining the effects of supporting wide-scale implementation of evidence-based practices to reduce opioid overdose deaths. One strategy involved implementation of MOUD linkage programs within five Kentucky county jails. Minutes from program planning and maintenance meetings led by HCS-KY implementation facilitators with linkage staff/supervisors and jail liaisons/partners (average of five participants/meeting) were coded following PRISM-RE-AIM using template analysis to understand variations in participation across sites as well as barriers to and facilitators of MOUD linkage implementation.</p><p><strong>Results: </strong>Across the five jails, 277 participants met with linkage staff during and/or post-incarceration for 1,119 visits conducted in-person or via phone/video conference. Twenty-six participants linked to community-based MOUD treatment during the implementation period. Participation differed across sites based on jail and linkage staff utilization of implementation support strategies but did not affect program sustainment, which all jails pursued in some form. Qualitative analysis yielded four overarching themes characterizing jail linkage program implementation. First, program integration into jail infrastructure entailed navigation of jail facilities and technologies as well as legal factors surrounding linkage staff backgrounds and information-sharing. Second, adapting the intervention to site-specific needs required providing training and implementation support to jail and linkage staff tailored to each jail context. Third, facilitating inter-organizational and cross-system coordination was related to collaboration successes and challenges among the HCS-KY team, linkage staff, the courts, and other provider partners. Finally, staffing and legal factors influenced sustainment.</p><p><strong>Conclusions: </strong>Only ~ 10% of participants linked to community-based MOUD despite intensive implementation support, yet jails highly valued the program and planned for sustainment. Given the complexities in postponing treatment initiation until reentry, we call for simultaneous efforts to integrate MOUD screening and treatment into jail booking processes.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"20"},"PeriodicalIF":3.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical multimorbidity, concurrent psychiatric morbidity, and emergency department presentation among adults released from prison: a prospective cohort study from Queensland, Australia.","authors":"Elliott Cope, Stuart Kinner, Rohan Borschmann, Jesse Young","doi":"10.1186/s40352-025-00322-y","DOIUrl":"https://doi.org/10.1186/s40352-025-00322-y","url":null,"abstract":"<p><strong>Background: </strong>People released from prison have elevated rates of physical and psychiatric morbidity, and emergency department (ED) presentation when compared with the general population. However, little is known about the specific health concerns that are associated with these high rates of ED presentation. The aims of this study were to (a) ascertain the prevalence of multimorbidity (physical multimorbidity and concurrent psychiatric morbidity) in a sample of adults prior to release from prison, and (b) examine the association between physical multimorbidity, psychiatric morbidity, and ED presentations in this sample following release from prison.</p><p><strong>Methods: </strong>We prospectively linked pre-release survey data collected between 1 August 2008 and 31 July 2010 from a representative cohort of 1325 sentenced adults in Queensland, Australia, to person-level ED, correctional, and death records. We assessed the multimorbidity of participants using the Cumulative Illness Rating Scale. The association between multimorbidity and rate of ED presentations was assessed by fitting a multivariable Andersen-Gill model to identify sociodemographic and criminal justice covariates. A sensitivity analysis was also conducted in which psychiatric morbidity was disaggregated into a 4-level dual diagnosis variable (none, mental illness only, substance use disorder only, dual diagnosis) and was fit separately from the physical multimorbidity measure to ascertain the degree to which these factors predicted ED presentation rates.</p><p><strong>Results: </strong>502 (48.0%) participants had multimorbidity, 265 (25.3%) had physical multimorbidity, and 608 (58.2%) had psychiatric morbidity. After adjustment for model covariates including dual diagnosis status, there was no statistically significant association between physical multimorbidity and ED presentation rate. However, after adjusting for model covariates including physical multimorbidity, participants with a diagnosis of either mental illness (aHR: 1.48; 95%CI: 1.08-2.03) or both mental illness and substance use disorder (aHR: 1.78; 95%CI: 1.33-2.37) had a higher rate of ED presentation than their counterparts without these diagnoses.</p><p><strong>Conclusion: </strong>The presence of psychiatric morbidity is associated with an increased rate of ED presentation. Targeted interventions for adults released from prison with psychiatric morbidity are urgently needed.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"19"},"PeriodicalIF":3.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}