Patient, medical and legal perspectives on reentry: the need for a low-barrier, collaborative, patient-centered approach

Background Worldwide, the United States has the highest incarceration rate per capita. Thousands of people are released from US correctional facilities each year, including many who are impacted by HIV infection and substance use disorder (SUD), two frequently comorbid conditions that present multiple challenges upon reentry. Reentry and care engagement research involving justice-involved people with HIV (PWH) with comorbid SUD has been largely limited to the perspective of those released. To formulate effective interventions for this population aimed at maintaining health and reducing recidivism, it is crucial to collect data from formerly incarcerated individuals with firsthand experience of the reentry process as well as other actors within the reentry framework. Insights from medical and legal service providers working in reentry systems have the potential to address key implementation concerns. To inform an intervention aimed at helping recently-released individuals PWH and SUD, we conducted a qualitative study to assess barriers and facilitators to community reentry from the perspectives of diverse consumers and providers of medical, legal, and reentry services. Results Fifteen stakeholders within XXX County participated in in-person interviews. Results indicated that 1) Patients/clients emphasized psychosocial support and individual attitude more than medical and legal participants, who chiefly focused on logistical factors such as finances, housing, and transportation; 2) Patients/clients expressed both medical and legal needs during the reentry period, though medical providers and participants from legal entities mainly expressed concerns limited to their respective scopes of work; 3) All three participant groups underscored the need for a low-barrier, collaborative, patient-centered approach to reentry with the goal of achieving self-sufficiency. Conclusions Findings support and extend existing literature detailing the barriers and facilitators to successful reentry. Our findings underscore the notion that an effective reentry intervention addresses both medical and legal needs, includes an individualized approach that incorporates psychosocial needs, and focuses on establishing self-sufficiency.

Determinants of Racial Disparities in Female Incarceration Rates, 2000–2018

In The Growth of Incarceration in the United States, the National Research Council documents the large and persistent racial disparities in imprisonment that accompanied the more than quadrupling of the U.S. incarceration rate since the 1980s. Largely unnoticed by policy makers and opinion leaders in recent years is an unprecedented decrease in the number of African American women incarcerated at the same time that the number of white women in prison has grown to new heights. The result of these recent changes is a near convergence in black-white female incarceration rates from 2000 to 2016. In some states, the changes occurred abruptly and almost instantaneously. In other states, the convergence has been gradual. We find that changes in the population composition—the fraction of the population that is black—was the major contributor to the decline in the disparity among women. We also find that race-specific differences in drug overdose deaths stemming from the recent increases in opioid use lowered the disparity by increasing the white female imprisonment rate and lowering it for black women.

MASK MANDATES REDUCE COVID-19 MORTALITY: Analysis of 37 States and the District of Columbia, with a further analysis of the impact of demographic and medical factors on efficacy.

As the number of COVID-19 deaths in the US increased, various policies were enacted to slow the spread of the pandemic. While the situation has improved in recent months, determining how best to combat the current pandemic is still essential. Failure to do so invites both further resurgences of the current pandemic, and more pandemics in the years to come. As a result of the widespread failure to contain the spread of COVID-19, enough deaths have occurred that the impact of policy on mortality may be statistically evaluated. This paper uses Optimal Discriminant Analysis (ODA) to evaluate the hypothesized ability of limited mask mandates (MM) to reduce the daily number of COVID-19 deaths in the states analyzed. The mandates were found to reduce mortality in half the states analyzed and did not result in increased mortality in any states. A full range of cofactors were analyzed to determine which, if any, influenced the efficacy of the mandates in the states in which mandates had an effect. Institutional Health Subindex of the Social Capital Index, state health score, population density, portion of the population with nongroup health insurance, state GDP, and the rate of pregnancy related diabetes were all correlated with increased mandate efficacy. In contrast, incarceration rate, overcrowded housing, severely overcrowded housing, portion of the population with military provided insurance, portion of the population uninsured, the portion of the population unable to see a doctor due to cost, and the portion of the population who were American Indian/Native Alaskan were all correlated with reduced mandate efficacy.

Association of census tract-level incarceration rate and life expectancy in New York State

BackgroundJail incarceration rates are positively associated with mortality at the county level. However, incarceration rates vary within counties, limiting the generalisability of this finding to neighbourhoods, where incarceration may have the greatest effects.MethodsWe performed a cross-sectional analysis of census tract-level state imprisonment rates in New York State (2010) and life expectancy data from the US Small-area Life Expectancy Estimates Project (2010–2015). We modelled fixed-effects for counties and controlled for tract-level poverty, racial makeup, education, and population density from the American Community Survey (2010–2014), and violent crime data from the New York City Police Department (2010). We also examined interactions between incarceration rate and poverty, racial makeup, and population density on life expectancy.ResultsLife expectancy at the highest quintile of incarceration was 5.5 years lower than in the lowest quintile, and over 2 years lower in a fully-adjusted model. Census tract-level poverty and racial makeup both moderated the association between incarceration and life expectancy.ConclusionCensus tract-level incarceration is associated with lower life expectancy. Decarceration, including alternatives to incarceration, and release of those currently incarcerated, may help to improve life expectancy at the neighbourhood level.

The cumulative risk of jail incarceration

Research on incarceration has focused on prisons, but jail detention is far more common than imprisonment. Jails are local institutions that detain people before trial or incarcerate them for short sentences for low-level offenses. Research from the 1970s and 1980s viewed jails as “managing the rabble,” a small and deeply disadvantaged segment of urban populations that struggled with problems of addiction, mental illness, and homelessness. The 1990s and 2000s marked a period of mass criminalization in which new styles of policing and court processing produced large numbers of criminal cases for minor crimes, concentrated in low-income communities of color. In a period of widespread criminal justice contact for minor offenses, how common is jail incarceration for minority men, particularly in poor neighborhoods? We estimate cumulative risks of jail incarceration with an administrative data file that records all jail admissions and discharges in New York City from 2008 to 2017. Although New York has a low jail incarceration rate, we find that 26.8% of Black men and 16.2% of Latino men, in contrast to only 3% of White men, in New York have been jailed by age 38 y. We also find evidence of high rates of repeated incarceration among Black men and high incarceration risks in high-poverty neighborhoods. Despite the jail’s great reach in New York, we also find that the incarcerated population declined in the study period, producing a large reduction in the prevalence of jail incarceration for Black and Latino men.

Comparative Observation on the Effect of Vancomycin-Loaded Calcium Sulfate on Promoting the Natural Healing of the Docking site of Bone Transport

Objectives: Observe the efficacy of vancomycin-loaded calcium sulfate（VCS）in promoting the natural healing of bone transport's docking site.Methods: We retrospectively analyzed 48 patients who used bone transfer to treat the tibia's infectious bone defects from 2013 to 2018. The patients were randomly divided into an experimental group receiving VCS treatment or a control group not receiving VCS treatment. After treatment, the two groups of docking site healing time, skin incarceration rate, natural healing rate, external fixation index, bony results, and functional results were compared.Results: The experimental group achieved bone healing in the docking site union for an average of (15.30±6.32) months after the operation. Among them, 25 cases healed spontaneously, two patients healed after bone cleaning and grafting; the average external fixation index was (2.10 ± 0.28) months/cm; Bone results: excellent in 19 cases, right in 7 patients, low in 1 case, functional derivatives: excellent in 16 points, good in 9 cases, and fair in 2 cases. The control group achieved bone healing at the docking site for an average of (15.29±5.36) months after the operation. Among them, 11 cases healed spontaneously at the docking site, and 10 cases of non-natural healing (6 points of skin incarceration) healed after cleaning and bone grafting; the average external fixation index was (2.09±0.25) months/cm; Bone results: excellent in 15 cases, right in 5 patients, fair in 1 case, functional products: excellent in 12 points, good in 8 cases, and fitting in 1 case. There was no significant difference in the healing time, bony results, functional results, and external fixation index between the two groups at the docking site (P>0.05). The experimental group's skin incarceration rate was lower than that of the control group, and the natural healing rate was higher than that of the control group (P<0.05).Conclusion: In bone removal surgery, the implantation of VCS in the infected bone defect area helps prevent the docking site skin incarceration and promotes the docking site's natural healing.

An Expanded Analytical Gaze on Penal Power: Border Criminology and Punitiveness

Border criminology authors have recently called for an expansion of criminological conceptions on penal power to include migration law enforcement devices. An amplified analytical gaze on penality is critical to challenge mainstream notions of punitiveness—an academic effort that is particularly relevant because incarceration rates are declining in many Global North jurisdictions. This paper explores various implications of this border criminology contribution to academic debates on punitiveness by investigating the interrelation of incarceration rate changes with detention and deportation data. In so doing, it contributes to the burgeoning theoretical debate on the impact of immigration enforcement policies on current penal changes.

The Potential of Community Corrections to Reduce Mass Incarceration in the USA

Tough-on-crime policies and strategies, such as mandatory minimum and determinate sentencing laws and more severe punishments for juveniles, sex offenders, and drug offenders, have caused a substantial increase in the U.S. incarceration rate. Mass incarceration has generated several negative consequences, including racial bias and disparities, economic and social costs, and prison overcrowding. As such, the use of community corrections programs as an alternative form of sentencing has significantly increased. To effectively reduce crime and recidivism, community corrections programs must 1) utilize a validated risk and needs assessment when determining program placement; 2) provide participants with comprehensive, evidence-based services, including substance abuse and mental health treatment; 3) focus on modifying participants' behavior through treatment goal setting and the use of graduated incentives and sanctions; and 4) strive to hire and retain qualified staff, provide both initial and ongoing training, and monitor treatment staff with regular clinical supervision.

Patterns and Predictors of Reincarceration among Prisoners with Serious Mental Illness: A Cohort Study: Modèles et Prédicteurs de Réincarcération Chez les Prisonniers Souffrant de Maladie Mentale Grave : Une Étude de Cohorte

Background: A small proportion of people who have serious mental illness and rapid and frequent incarcerations account for a disproportionate amount of overall service use and cost. It is important to describe such individuals, so that services can respond more effectively. Methods: We investigated a cohort of 4,704 incarcerated men and women who were discharged from a correctional mental health service and followed for a median of 535 days. We investigated social, clinical, demographic, and offense characteristics as predictors of return to the service using Cox survival analyses. Secondly, we characterized individuals as high-frequency service users as those who had 3 or more incarcerations during a 1-year period and investigated their characteristics. Results: We found that a higher rate of return to custody was associated with schizophrenia spectrum/bipolar affective disorder (BPAD), personality disorder traits, crack cocaine and methamphetamine use, and unstable housing. Charges of theft/robbery and breach of probation were also positively associated, and sex assault was negatively associated with return to custody. Within a 1-year time period, we found 7.2% of individuals were high-frequency service users, which accounted for 19.5% of all reincarcerations. Conclusion: Identification of the characteristics of those with mental illness in custody, especially those who have high-frequency returns to custody, may provide opportunity to target resources more effectively. The primary targets of intervention would be to treat those with schizophrenia/BPAD and substance use problems, particularly those using stimulants, and addressing homelessness. This could reduce the problem of repeated criminalization of the mentally ill and reduce the overall incarceration rate.

Local Labor Market Inequality in the Age of Mass Incarceration

We contend that the rise of mass incarceration in the United States can be framed through the lens of stratification economics, which views race- and class-based discrimination as a rational attempt on behalf of privileged groups to preserve their relative status and the material benefits which that status confers. Using the first (to our knowledge) local-level data set on incarceration rates by race, we explore the relationship between income inequality, poverty, and incarceration at the commuting zone level from 1950 to the present. Consistent with Michelle Alexander’s hypothesis that expansion of the penal system and the rise of “tough on crime” policy were efforts by privileged groups to drive a wedge into working-class political coalitions formed out of the Civil Rights Movement, we find that labor markets with greater inequality experienced larger increases in the overall incarceration rate. Furthermore, we find that relative rates of poverty play a key role in explaining differential effects of mass incarceration across race. Areas where White poverty rates were large relative to non-White poverty rates experienced no significant change in White incarceration, but an expansion of non-White incarceration. These findings have implications for policies related to economic and judicial systems.