Health and Justice最新文献

{"title":"Implementation of carceral medicaid suspension and enrollment programs: perspectives of carceral and medicaid leaders.","authors":"Sachini Bandara, Brendan Saloner, Hannah Maniates, Minna Song, Noa Krawczyk","doi":"10.1186/s40352-024-00311-7","DOIUrl":"10.1186/s40352-024-00311-7","url":null,"abstract":"<p><strong>Background: </strong>Medicaid expansion via the Affordable Care Act, more recent legislation and Medicaid 1115 waivers offer opportunity to increase health care access among individuals involved in the carceral system. Effective enrollment of new beneficiaries and temporary suspension and reactivation of existing Medicaid benefits upon release is key to the success of these efforts. This study aims to characterize how jails, prisons and Medicaid agencies are implementing Medicaid suspension and enrollment programs and identifies barriers and facilitators to implementation.</p><p><strong>Methods: </strong>We conducted 19 semi-structured interviews with 36 multi-state leaders in carceral facilities, Medicaid agencies, local health departments and national policy experts from 2020 to 2021. Interviews covered 4 domains: (1) the role of policy in influencing carceral and reentry Medicaid practices, (2) implementation strategies to suspend and enroll incarcerated individuals into Medicaid, (3) barriers and facilitators to successful implementation, and (4) variation in implementation between jails and prisons.</p><p><strong>Results: </strong>Participants identified logistical challenges with suspension and enrollment, including limited infrastructure for data sharing between carceral facilities and Medicaid agencies, burdensome bureaucratic requirements, and challenges with Medicaid renewal, particularly in the jail environment. They offered opportunities to overcome barriers, such as the creation of specialized incarcerated Medicaid benefit categories and provision of in-reach services via managed care organizations. Participants also called for improvements to Medicaid reactivation processes, as even when facilities successfully suspended benefits, individuals faced significant challenges and delays reactivating benefits upon release. Participants also called for further loosening of the Medicaid Inmate Exclusion Policy.</p><p><strong>Discussion: </strong>Findings highlight the need to update data sharing infrastructure, which will be critical to the implementation of the 1115 waivers, as carceral facilities will be subject to Medicaid billing and reporting requirements. In addition to investing in the ability to newly enroll and suspend Medicaid benefits, attention towards improving timely reactivation practices is needed, particularly given the highly elevated risk of mortality immediately after release. Participants calls for further reforms to the Medicaid Inmate Exclusion Policy are consistent with proposed legislation.</p><p><strong>Conclusions: </strong>Findings can critically inform the successful implementation of Medicaid-based reforms to improve the health of incarcerated and formerly incarcerated people.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"1"},"PeriodicalIF":3.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956456","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":"Improving first responders' perceptions of overdose events and survivors through tailored occupational health-focused training co-facilitated by overdose survivors.","authors":"Rachel Winograd, Phillip L Marotta, Meghan M O'Neil, Saad Siddiqui, Elizabeth Connors, Anna La Manna, Jeremiah Goulka, Leo Beletsky","doi":"10.1186/s40352-024-00309-1","DOIUrl":"10.1186/s40352-024-00309-1","url":null,"abstract":"<p><strong>Background: </strong>First responders (law enforcement officers, emergency medical services, and firefighters) frequently interact with people who use drugs (PWUD). Based on the nature and outcomes of such encounters, these interactions have the potential either to reduce harm, or perpetuate it. Given increased funding and attention for first responder-led interventions involving PWUD, we must identify the most critical training for improving negative beliefs about these interventions and populations. In this study, we aimed to develop and evaluate a novel, evidence-based first responder training with an occupational wellness framing aiming to increase knowledge regarding and improve attitudes toward people who overdose and toward the overdose antidote, naloxone.</p><p><strong>Methods: </strong>We developed and evaluated the DOTS/SHIELD (Drug Overdose Trust & Safety/Safety & Health Integration in the Enforcement of Laws on Drugs) first responder training with three components: (1) matched first responder and overdose survivor trainers; (2) locally tailored substance use service information and practical referral instructions; and (3) occupational health content designed to make first responders' jobs easier and safer. We conducted pre- and post-tests at 151 Missouri-based trainings (December 2020-May 2023) to assess associated attitudinal changes among law enforcement vs. emergency medical services [EMS]/fire.</p><p><strong>Results: </strong>Among the matched sample (N = 1,003, 53.9% law enforcement), post-training attitudes toward people who overdose and toward naloxone were more positive than pre-training attitudes. On average, law enforcement held worse attitudes than EMS/fire toward people who overdose, though there were no professional differences in naloxone-related beliefs.</p><p><strong>Conclusions: </strong>This training approach effectively combines three training components - peer trainers, practical substance use service referral information, and an occupational wellness framing - to positively influence first responders' views toward those who use drugs and toward naloxone.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"12 1","pages":"49"},"PeriodicalIF":3.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855713","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 effects of message framing on US police chiefs' support for interventions for opioid use disorder: a randomized survey experiment.","authors":"Brandon Del Pozo, Saba Rouhani, Amelia Bailey, M H Clark, Kaitlin F Martins, Fatema Z Ahmed, Danielle Atkins, Barbara Andraka-Christou","doi":"10.1186/s40352-024-00306-4","DOIUrl":"10.1186/s40352-024-00306-4","url":null,"abstract":"<p><strong>Background: </strong>US chiefs of police hold significant influence over the perceived acceptability and appropriateness of interventions for opioid use disorder (OUD) among the public, elected officials, and subordinate officers. This study assessed whether police chiefs' support for such interventions was sensitive to framing an intervention's benefits in terms that emphasize public health and harm reduction outcomes, versus terms typically indicative of public safety outcomes.</p><p><strong>Methods: </strong>A two-armed survey utilizing a randomized, between-subjects design tested framing-based variance in support among US chiefs of police for overdose prevention centers, syringe service programs (SSPs), Good Samaritan laws, police naloxone distribution, trustworthiness of officers in recovery from OUD, and related propositions. Of 1,200 invitations, 276 chiefs participated (23%). The two experimental arms (n = 133, n = 143) were demographically balanced between both each other and non-respondents.</p><p><strong>Results: </strong>Chiefs were more likely to agree that their mission was protecting public safety than protecting public health, even when both were defined using public health outcomes. Chiefs expressed significantly greater support for \"overdose prevention sites\" than \"safe injection sites\" (p = .018), low levels of support for SSPs regardless of framing (18% safety; 19% health), and comparably more support for Good Samaritan laws based on framing (62% safety vs. 54% health). Respondents voiced low levels of trust in officers recovering from OUD generally (31%), and significantly lower levels of trust when recovery involved the medication buprenorphine (10%; p < .001). Senior chiefs were significantly more likely to support SSPs (aOR 1.05; CI 1.01, 1.09) and overdose prevention sites (aOR 2.45; CI 1.13, 5.28) than less senior chiefs.</p><p><strong>Conclusions: </strong>In this cross-sectional survey experiment, support for some interventions for OUD was greater among US chiefs of police when framed to emphasize positive public safety outcomes. Research is required to better understand low support for SSPs, mistrust of officers in recovery for OUD, and greater support for OUD interventions among senior chiefs.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"12 1","pages":"50"},"PeriodicalIF":2.6,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855747","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":"Correctional officers and the ongoing health implications of prison work.","authors":"William J Schultz, Rosemary Ricciardeli","doi":"10.1186/s40352-024-00308-2","DOIUrl":"10.1186/s40352-024-00308-2","url":null,"abstract":"<p><p>Correctional Service Providers (CSP), including Correctional officers (COs), are key front-line figures in prisons globally, with responsibility for a wide range of daily prison operations. Over the past decade, research on prison staff has massively grown. However, the portrait this scholarship draws is concerning. Research focusing on the physical, mental, and social wellbeing of prison staff consistently paints a picture of a deeply unhealthy group of people, with above-average levels of physical health concerns. Likewise, recent literature suggests correctional employees are facing a mental health crisis, with high prevalence of mental health disorders and self-harming behaviors, even when compared to other law enforcement personnel. Further, scholars have expressed concerns about the social and cultural wellbeing of staff, factors that directly impact daily prison operations. We conduct a broad overview of the literature on correctional worker health and wellness, identifying key themes and major areas of concern. We conclude by identifying key challenges and proposing areas for future research.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"13 1","pages":"4"},"PeriodicalIF":3.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013412","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":"Jail-based interventions to reduce risk for opioid-related overdose deaths: Examples of implementation within Ohio counties participating in the HEALing Communities Study.","authors":"Joel Sprunger, Jennifer Brown, Sofia Rubi, Joan Papp, Michael Lyons, T John Winhusen","doi":"10.1186/s40352-024-00307-3","DOIUrl":"10.1186/s40352-024-00307-3","url":null,"abstract":"<p><strong>Background: </strong>Opioid-related overdose is a leading cause of death for criminal legal-involved individuals and, although naloxone distribution and medications for opioid use disorder (MOUD) are effective means for reducing post-release overdose death risk, jail-based availability is limited. This case report describes the challenges faced by three Ohio communities as they implemented evidence-based practices (EBPs) in jails to combat post-release opioid overdose deaths.</p><p><strong>Method: </strong>We present case examples of how barriers were overcome to implement jail-based EBPs in three Ohio communities (two urban and one rural) as part of the HEALing Communities Study (UM1DA049417; ClinicalTrials.gov Identifier: NCT04111939). Of the 18 participating Ohio HEALing Communities Study counties, we highlight 3 communities for the novelty of their EBPs implemented, the challenges that they faced, and their rural/urban status. We present descriptive data regarding the EBPs that they implemented and discuss the challenges identified by HEALing Communities Study staff with first-hand experience facilitating their implementation.</p><p><strong>Results: </strong>Newly implemented interventions included overdose education and direct provision of naloxone to incarcerated individuals upon release (2 of 3 communities), initiating MOUD prior to release (3 of 3), linkage to ongoing MOUD treatment in the community (2 of 3), peer support-facilitated treatment retention efforts (2 of 3) and emergency housing (1 of 3) in the immediate post-incarceration period. Common challenges that emerged included skepticism about the need and feasibility of implementing EBPs to reduce overdose and death, lack of knowledge about the options available and whether external agencies may assist, and difficulty engaging stakeholders to overcome inertia.</p><p><strong>Conclusions: </strong>Creative flexibility, calm persistence, technical facilitation, and collaboration with community service providers were assets that helped these Ohio jails implement evidence-based strategies that combat the opioid epidemic and reduce the likelihood of post-incarceration overdose and death in a high risk, formerly incarcerated population.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"12 1","pages":"48"},"PeriodicalIF":3.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787115","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":"Some improvements but a long way to go: a national survey of local authorities on the provision of social care for people released from prison.","authors":"Claire Hargreaves, Amy Roberts, Wendy Taylor, Katrina Forsyth, Catherine Robinson, Jennifer Shaw, Susan Tucker","doi":"10.1186/s40352-024-00304-6","DOIUrl":"10.1186/s40352-024-00304-6","url":null,"abstract":"<p><p>The provision of social care for people in prison in England has historically been lacking. Seeking to address this, the 2014 Care Act clarified that local authorities are responsible for identifying, assessing and meeting prisoners' social care needs. Against this background, in 2020 we undertook a survey to explore the emerging services for this group. Eighty-six (57%) local authorities responded. A mixed methods approach was taken. Numerical data were analysed through descriptive statistics with comparisons made to the previous survey. An inductive approach to thematic analysis was used to analyse the free text responses. The findings revealed some improvements since the 2015/16 surveys, including the wider introduction of self-referral systems, the success of peer supporters in identifying people in need of social care and greater multi-disciplinary working. However, other issues remained stubbornly persistent, including a dearth of systematic processes to identify those needing social care on release from prison, a lack of timely information sharing and disputes over the sending and receiving authorities' responsibilities. There were also particular concerns about the shortage of appropriate accommodation for people leaving prison. Perhaps the most striking finding, however, was how little most authorities knew about this population. Building on discussions in previous papers, we explore three ways in which arrangements could be strengthened for this group: the collection of better data, the wider use of release on temporary licence and the greater employment of technology in planning people's release.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"12 1","pages":"47"},"PeriodicalIF":3.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751922","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":"Treatment utilization among people with drug use disorders in prison: a national longitudinal cohort study.","authors":"Nicoline Toresen Lokdam, Marianne Riksheim Stavseth, Ingeborg Skjaervø, Anne Bukten","doi":"10.1186/s40352-024-00302-8","DOIUrl":"10.1186/s40352-024-00302-8","url":null,"abstract":"<p><strong>Background: </strong>Drug use disorders are highly prevalent among people in prison. Nevertheless, treatment coverage for individuals with drug use disorders in prison remains understudied and unknown. The aim of this study was to estimate treatment coverage among a sample of people with harmful and likely drug dependence before entering prison and to investigate the factors associated with treatment utilization.</p><p><strong>Methods: </strong>This was a longitudinal cohort study using baseline survey data linked to registry data on imprisonment and treatment utilization. The study is based on the Norwegian Offender Mental Health and Addiction (NorMA) cohort (n = 733) recruited in 2013-2014 from 57 Norwegian prisons. At baseline, participants reported drug use the year before imprisonment, using the Drug Use Disorder Identification Test (DUDIT). The outcome of interest was DUD treatment, defined as at least one DUD treatment episode from the specialized health services during baseline imprisonment.</p><p><strong>Results: </strong>40% of the sample had DUDIT scores that indicated likely drug dependence (≥ 25) and a need for treatment. Among this group, 64% received DUD treatment while imprisoned. Longer imprisonment (> 12 months; aOR = 8.87, p < 0.001), Nordic country of birth (aOR = 2.85, p = 0.003), daily/almost daily injecting drug use (aOR = 2.58, p < 0.001) and polydrug use (aOR = 2.19, p = 0.002) were positively associated with treatment utilization in prison.</p><p><strong>Conclusions: </strong>Most people with likely drug dependence before entering prison in Norway received DUD treatment during their time in prison. More severe drug use (Injecting drug use and polydrug use), longer imprisonments and being born in the Nordics were positively associated with treatment utilization. People in prison must have access to adequate treatment during imprisonment, and further studies should investigate the possible individual or structural barriers resulting in treatment gaps, especially for people who are foreign born and people with short sentences.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"12 1","pages":"46"},"PeriodicalIF":3.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717311","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 role of community health workers in re-entry of people with HIV and substance use disorder released from jail: a mixed methods evaluation of a pilot study.","authors":"Afeefah Khazi-Syed, Emily Hoff, Maverick Salyards, Laura Hansen, Nicholas Campalans, Zoe Pulitzer, Christina Melton Crain, Hue Nguyen, Shira Shavit, Robrina Walker, Ank E Nijhawan","doi":"10.1186/s40352-024-00301-9","DOIUrl":"10.1186/s40352-024-00301-9","url":null,"abstract":"<p><strong>Background: </strong>Incarcerated individuals face high rates of mental illness, substance use disorders and communicable diseases including HIV, with increased health complications and mortality in the early post-release period. Multiple re-entry interventions linking justice-involved individuals to community resources via peer navigation have emerged, though limited data exist on the mechanics and personal impact of these approaches. This paper quantifies and evaluates a pilot study of a combined Community Health Worker (CHW)-re-entry intervention for individuals released from jail who use substances and have HIV to inform future large-scale applications.</p><p><strong>Methods: </strong>A mixed-methods analysis of a CHW-re-entry intervention utilized in a pilot randomized controlled trial involving people with HIV who have a history of substance (stimulant, opioid or alcohol) use in Dallas, TX was conducted using an explanatory sequential design. Quantitative assessments of the intervention measured interaction types, time spent, and topics discussed and explored associations between the \"dose\" of intervention and patient outcomes. Qualitative analyses of CHW field notes and end-of-study participant interviews were triangulated with quantitative findings to elucidate the intervention's impact.</p><p><strong>Results: </strong>Of the 17/31 participants assigned to the intervention, 16 interacted with the CHW on at least one occasion, and 6 successfully completed a visit with the re-entry organization. Most CHW interactions occurred by phone (66%) or in person (28%). Frequently discussed topics included substance use, housing, and physical health. On average, participants spent 7.65 h (range 0-37.18, SD = 9.33) engaged with the intervention over 6 months. Intervention dose was associated with improved HIV control, decreased stimulant use, higher rates of recidivism, and improved clinical appointment show rate. Qualitative analyses revealed key intervention components, paralleling benefits of study participation alone: outreach, nonjudgmental approach, motivation and accountability.</p><p><strong>Conclusions: </strong>A CHW-re-entry intervention, while resource-intensive, shows preliminary promise in improving HIV and some substance use outcomes. Frequent telephone and in-person contact, with an empathetic yet goal-oriented approach, fostered participant support and motivation to address HIV and substance use. Participants reported that engagement in research provided accountability and a sense of purpose. Future studies should focus on optimizing implementation of CHW-based interventions to enhance impact on vulnerable populations.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"12 1","pages":"45"},"PeriodicalIF":3.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11587591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711156","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":"\"They are trying their best\": incarcerated individuals' assessment of general healthcare services in selected Ghanaian prisons.","authors":"Susanna Aba Abraham, Francis Annor, Obed Cudjoe, Benjamin Kofi Anumel, Dorcas Frempomaa Agyare, Benedict Osei Tawiah, Florence Djoletoe, Raphael Adu-Gyamfi, Kwadwo Koduah Owusu, Anthony Ashinyo, Dorcas Obiri-Yeboah","doi":"10.1186/s40352-024-00298-1","DOIUrl":"10.1186/s40352-024-00298-1","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization (WHO) has indicated that the absence of prison health poses a threat to public health, making it important to safeguard access to quality healthcare for incarcerated populations. Although several studies have explored the quality of care in prisons, there is a dearth of empirical evidence on the perspectives of incarcerated individuals. This study investigated incarcerated individuals' perspectives and opinions on the general healthcare services in Ghanaian prisons.</p><p><strong>Methods: </strong>Utilizing a qualitative approach, focus group discussions were conducted with 51 incarcerated individuals in five prisons sited in the Northern, Middle and Southern zones of Ghana. Thematic analysis following the tradition of Braun and Clarke was conducted. Four of the six constructs of the WHO Health Systems Framework - service delivery, health workforce, access to essential medicines, and leadership and guidance - were applied deductively to organise the data into themes and subthemes.</p><p><strong>Results: </strong>Four themes were generated from the analysis: \"Health service delivery\", \"Health workforce in prisons\", \"Access to essential medicines\" and \"Leadership; regulating healthcare services\". Participants rated health services in prisons as below average compared to those available to the general population. The use of nurses as prescribers in prison infirmaries, though consistent with Ghana Health Service policy, seems to negatively influence prisoners' perceptions of the quality of the health workforce in prisons. Lack of basic equipment and essential medications at the infirmary for common endemic conditions such as malaria coupled with the bureaucratic processes required to access care outside of the prison also negatively affected incarcerated individuals' perceptions of the quality of health care.</p><p><strong>Conclusions: </strong>Incarcerated individuals perceived that the quality of health services provided in prisons was inferior to that provided in the general population. Addressing challenges associated with the unavailability of essential drugs and equipment, improving the number of health staff, and addressing bottlenecks in accessing urgent care will enhance the experiences of incarcerated populations on the quality of care given.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"12 1","pages":"44"},"PeriodicalIF":3.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649058","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":"Pre and post diagnostic dementia care in four Scottish prisons.","authors":"Rhoda MacRae, Natalie Chalmers, Debbie Tolson, James Taylor, Kirstin Anderson, Lindsay Thomson, Tom Russ","doi":"10.1186/s40352-024-00294-5","DOIUrl":"10.1186/s40352-024-00294-5","url":null,"abstract":"<p><strong>Background and purpose: </strong>The number of older people in prisons is increasing across the globe. Many have poor physical and mental health, higher prevalence of head injury, cognitive impairment and dementia than found in community populations. Meeting the complex needs of this vulnerable group has become an increasing concern for prison and prison healthcare services. The aim of this multi method qualitative study was to investigate how men with diagnosed or suspected dementia were identified, assessed, and cared for in Scottish prisons. It also explored the lived experience of individuals being assessed for or diagnosed with dementia within four prisons. The data from twenty nine interviews was thematically analysed and used to collaboratively propose principles for dementia care in prison and present the resultant co-designed care pathway.</p><p><strong>Results: </strong>At the time of data collection almost all the men known to have a dementia diagnosis or suspected dementia had complex health and social care needs, and some were living with advanced dementia. Prison healthcare staff reported taking a 'case by case' approach to their pre- and post-diagnostic care. Meeting these prisoner's needs was complicated by the absence of organisational leads for care of older adults or people with dementia and there was no pathway or model in place to guide staff. Prison healthcare teams often had difficulty accessing specialist community services to support diagnosis. There was a lack of dementia education and knowledge about how to provide pre and post diagnostic dementia care in this setting amongst staff. The findings arising from this research have informed the co-production of two important evidence informed innovations namely a Model of Care and a pre- and post-diagnostic Care Pathway.</p><p><strong>Conclusion: </strong>This research adds insights critical to understanding the adequacy of current approaches to meeting dementia related needs within the prison setting. To our knowledge this paper offers the first co-produced evidence informed pre- and post- diagnostic dementia care pathway and model of care for use in prisons. These could serve as tools for change that could enable prison healthcare staff to deliver the right care, at the right time, by the right people, and provide an opportunity to assess risk and plan care for the future.</p>","PeriodicalId":37843,"journal":{"name":"Health and Justice","volume":"12 1","pages":"43"},"PeriodicalIF":3.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584614","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}