Journal of Correctional Health Care

In a case example from the Kentucky HEALing Communities Study, extensive resources were deployed to address structural barriers and facilitate the provision of medication for opioid use disorder (OUD) in an urban county jail. However, implementation was unsuccessful, and this case example emphasizes the importance of including evidence-based medication for OUD (MOUD) treatment in the scope of work of jails' contracted medical providers. The privatization of correctional health care services allows local governments with opioid abatement funds to incorporate requirements into medical provider contracts to screen all people entering jails for OUD and to offer MOUD at intake, throughout incarceration, and upon release to everyone for whom it is clinically indicated. We provide sample contractual language that can be added to requests for medical provider proposals to help drive the private correctional health care market toward integrating MOUD treatment into their standard of care. This approach also could expedite efforts to scale up broad MOUD access across U.S. jails through sharing of workflows and best practices among the small group of national correctional health care companies contracted with jails in states with broad mandates, such as Massachusetts.

Clinical Trial Registration: NCT04111939.

American jails process millions of bookings each year, and prior research has documented high rates of mental and physical ailments among people held in jails. The existing literature, however, provides only minimal insight into the occurrence of multiple health conditions. This study sought to estimate the prevalence of physical and mental health multimorbidity among people held in jails in the United States. Using a nationally representative sample of responses to the National Inmate Survey, 2011–2012 (N = 5,494), we analyzed reports of physical health conditions, mental health conditions, and disabilities among people in local jails. Prevalence of two or more conditions was 28.5% (95% confidence interval [CI] = 27.3%, 29.7%) for mental health, 55.5% (95% CI = 54.2%, 56.8%) for physical health, and 15.5% (95% CI = 14.6%, 16.5%) for disabilities. At least one condition across all three health domains was estimated at 29.4% (95% CI = 28.2%, 30.6%). Prevalence of two or more co-occurring conditions without regard for domain was 76.9% (95% CI = 75.8%, 78.0%). Rates were consistently higher among women than among men. Jailed people show a high rate of co-occurring mental and physical health conditions.

Although the harms of incarceration on health are well known, little is known about individuals' competing priorities to maintaining their health while on probation and parole after release from incarceration. We explored individuals' competing needs on probation and parole (lack of health insurance/access, hazardous alcohol use, substance use, food insecurity, un/underemployment, housing insecurity, lack of social support, length of recent incarceration, prohibitive monthly fees, criminal legal discrimination) to achieving well-being. We explored overlap between competing needs and overall well-being. This descriptive, cross-sectional analysis assesses the relationship between competing needs and current well-being of participants in The Southern Pre-Exposure Prophylaxis Study. Of 364 enrolled participants, 48% were thriving. The most common competing need was substance use (73%). Of the 10 competing needs, participants experienced a median 4 (interquartile range [IQR] 3–6). Those considered to be thriving experienced a median 4 (IQR 3–5) competing needs while those not thriving experienced a median 5 (IQR 4–6; p < .001). People on probation and parole experience competing needs to achieving health and well-being. To improve well-being among this population, programs and policies must focus on not only the health of those exiting incarceration but also the multiple competing needs that they face.

Reentry is a difficult juncture for young adults (ages 18–24 years), who simultaneously face challenges of emerging adulthood. Although their health-related needs may be substantial, little is reported on young adults' reentry health care and social service needs. Furthermore, empirical measurements of factors affecting their engagement in reentry services after jail are lacking. We sought to describe health needs and predictors of linkages to reentry services for the 2,525 young adult participants in the Whole Person Care–LA Reentry program (WPC Reentry). Descriptive statistics were calculated and chi-square tests, t tests, and logistic regression were performed to identify factors associated with linkage to WPC Reentry postrelease compared with only engaging with WPC Reentry prerelease. Most participants (72.6%) were male, 80.2% were Hispanic or Black, and 60.9% had been unhoused. Mental health (57.2%) and substance use disorders (45.8%) were common, physical health was overall good (mean Charlson Comorbidity Index score 0.53), and social needs, especially housing, were high (40.7%). Older age (i.e., closer to 25 years) and history of being unhoused were associated with higher postrelease engagement in WPC Reentry (age: odds ratio [OR] = 1.06, p = .01; history of being unhoused: OR = 1.18, p = .05). Attentiveness to younger clients and to addressing housing needs may be key for successful reentry care linkages.

Research on pandemics in institutional settings often assumes that all human interactions within a jail pose similar viral transmission risks. We developed an agent-based model (ABM) called Simulation Applications for Forecasting Effective Responses in Corrections (SAFER-C™) to simulate nine scenarios of possible interactions and virus transmission among incarcerated individuals and jail staff and tested this assumption. We found that resumption of high-contact activities has a greater impact on the number of infections, while out-of-cell group sizes and initial vaccination rates had lower impact. This work emphasizes the importance of understanding and modeling human interactions in confinement facilities, as well as understanding, responding to, and limiting the mechanism of viral transmission in jails. Insights from ABMs provide correctional administrators with realistic options for managing responses.

Since prisons were an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, the experience of correctional health care professionals (HCPs) may differ from HCPs in other settings. This cross-sectional descriptive study assessed stress, anxiety, and burnout levels in home and work environments among HCPs employed by one U.S. state prison system during the period of initial COVID-19 vaccine rollout. Participants (N = 444) were invited to voluntarily participate in an anonymous questionnaire distributed by prison administration from March 1 through May 17, 2021. Measures were adapted from a prior study of noncorrectional HCPs during the COVID-19 pandemic. Descriptive statistics (mean; standard deviation; 25th, 50th, and 75th percentiles), ranking measures that could alleviate anxiety and stress related to the pandemic, and qualitative responses were analyzed. Responses from 43% of HCPs (192) revealed that correctional HCPs experienced high levels of stress and anxiety at work and at home during the pandemic, with particularly high levels among females and registered nurses. Understanding and addressing these stressors will be of critical importance as prison systems work to avoid turnover of experienced HCPs in such specialized settings and also help inform human resource planning at state prison systems for future public health responses.

Sexual violence within prisons is a complex issue. The Prison Rape Elimination Act identifies standards to guide the provision of care to meet the medical and forensic needs of individuals who experience sexual assault (SA) while incarcerated. The standards include access to care by a Sexual Assault Nurse Examiner (SANE) whenever possible. Telehealth is one solution to ensure expert SANE access. This brief report addresses the pre-examination concerns/worries and immediate post-examination perceptions and experiences of six individuals who experienced SA while incarcerated. Findings show resolution of pre-examination worries, high satisfaction with care, high telehealth acceptability rates, and universal endorsement that examinations should occur outside of correctional facilities. Although not generalizable, this report provides preliminary insight into care in an understudied population with unique health care needs.