Community Corrections Officers' Perspectives of the Impact of Hurricane Maria on the Participant's Mental Health and Substance Use: A Qualitative Content Analysis.

Objective: This study explored community supervision officers' perceptions of the individual, community, and organizational challenges confronted by program participants after Hurricane María and their recommendations for future emergency management.

Methods: A qualitative content analysis was conducted for nine focus group with community supervision officers in Puerto Rico. Participants were asked about their perceptions of how the mental health and drug abuse of persons on parole or probation were affected and the measures taken to address these concerns in disaster response.

Substance use policy and practice in the COVID-19 pandemic: Learning from early pandemic responses through internationally comparative field data.

The COVID-19 pandemic has created an unprecedented natural experiment in drug policy, treatment delivery, and harm reduction strategies by exposing wide variation in public health infrastructures and social safety nets around the world. Using qualitative data including ethnographic methods, questionnaires, and semi-structured interviews with people who use drugs (PWUD) and Delphi-method with experts from field sites spanning 13 different countries, this paper compares national responses to substance use during the first wave of the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 (SU x COVID) Data Collaborative, an international network of social scientists, public health scientists, and community health practitioners convened to identify and contextualise health service delivery models and social protections that influence the health and wellbeing of PWUD during COVID-19.

Involuntary Civil Commitment for Substance Use Disorders in Puerto Rico: Neglected Rights Violations and Implications for Legal Reform.

Laws facilitating the involuntary civil commitment (ICC) of people with substance use disorders vary considerably internationally and across the United States. Puerto Rico, a colonial territory of the United States since 1898, currently harbors the most punitive ICC legislation in the country. It is the only place in the United States where self-sufficient adults who pose no grave danger to themselves or others can be involuntarily committed to restrictive residential facilities for over a year at a time without ever being assessed by a health care professional.

Cultural adaptation and psychometric properties of the Substance Abuse Self-Stigma Scale among Latinos with Substance Use Disorders: An effective screening tool for correctional and community settings.

The present study involves a psychometric evaluation of the Substance Abuse Self-Stigma Scale (SASSS), a 40-item dimensional measure of internalized or self-stigma developed by Jason Luoma and collaborators, among Latinos with Substance Use Disorders (SUDs). The current study's specific aim is to assess the psychometric properties (factor structure and reliability) of the translated and culturally adapted SASSS instrument in a cross-sectional study of individuals ( = 412) with SUDs with or without HIV from correctional facilities and community treatment programs. A confirmatory factor analysis evidenced the four-factor structure of SASSS.

The Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN-PATHS): A hybrid type-1 effectiveness trial of enhanced primary care to improve opioid use disorder treatment outcomes following release from jail.

Background: In 2016, at least 20% of people with opioid use disorder (OUD) were involved in the criminal justice system, with the majority of individuals cycling through jails. Opioid overdose is the leading cause of death and a common cause of morbidity after release from incarceration. Medications for OUD (MOUD) are effective at reducing overdoses, but few interventions have successfully engaged and retained individuals after release from incarceration in treatment.

Attention Deficit Hyperactivity Disorder in Prisoners: Increased Substance Use Disorder Severity and Psychiatric Comorbidity.

Objectives: Attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD) are overrepresented among incarcerated populations. We examined whether ADHD was associated with increased severity of comorbid SUD and with increased psychiatric comorbidity among prisoners.

Methods: Cross-sectional study of 500 randomly selected Latino male prisoners in the Puerto Rico Correctional System using validated diagnostic measures to assess Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ADHD and SUD diagnosis, antisocial personality disorder (ASP) and borderline personality disorder (BPD), major depression, and generalized anxiety disorder (GAD).

Sex differences in traumatic events and psychiatric morbidity associated to probable posttraumatic stress disorder among Latino prisoners.

Latinos comprised 17.1% of the U.S.

Beyond negative attitudes: Examining HIV/AIDS stigma behaviors in clinical encounters.

HIV/AIDS related stigma remains a major global health issue with detrimental consequences for the treatment and health of people with HIV/AIDS (PWHA), especially when manifested by health professionals. Research on HIV/AIDS stigma has successfully documented negative attitudes towards PWHA among health professionals. However, fewer studies have examined how stigma is manifested behaviorally by health professionals during clinical interactions.

History of Solitary Confinement Is Associated with Post-Traumatic Stress Disorder Symptoms among Individuals Recently Released from Prison.

This study assessed the relationship between solitary confinement and post-traumatic stress disorder (PTSD) symptoms in a cohort of recently released former prisoners. The cross-sectional design utilized baseline data from the Transitions Clinic Network, a multi-site prospective longitudinal cohort study of post-incarceration medical care. Our main independent variable was self-reported solitary confinement during the participants' most recent incarceration; the dependent variable was the presence of PTSD symptoms determined by primary care (PC)-PTSD screening when participants initiated primary care in the community.

Attention deficit hyperactivity disorder symptoms, type of offending and recidivism in a prison population: The role of substance dependence.

Background: It is unclear whether adult offenders with a history of attention deficit hyperactivity disorder (ADHD) are more likely to re-offend, and if so, in any specific offences.

Aim: This study aimed to examine correlates of childhood ADHD symptoms among prisoners.

Methods: A randomly selected sample of 1179 participants from the adult sentenced population of Puerto Rico (USA) reported their history of violent and non-violent offences, age of first arrest and re-offending.

Knowledge of Case Workers and Correctional Officers towards HIV and HCV Infections: Opportunity for Public Health Education in the Correctional System.

Objective: Given the heavy burden of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections in correctional facilities, we examined knowledge about these infections among case workers and correctional officers in penal institutions in Puerto Rico.

Methods: We used data from a cross-sectional study of state prisons, commissioned by the Puerto Rico Department of Correction and Rehabilitation, to assess knowledge about HCV and HIV (10 items each) among 256 case workers and correctional officers from 18 penal institutions selected in the prison system. Total scores for each scale ranged from 0 to 10 points, with higher scores reflecting more knowledge.

Medical Costs of Persons with Drug Use Disorders Among Medicaid Managed Care Beneficiaries in Puerto Rico : Comparison of the Direct Services Costs Incurred by Beneficiaries With and Without a Drug Use Disorder.

Drug use disorders (DUDs) can substantially increase the costs of health care, especially when left untreated. Yet, not much is known about the specific types of medical services that give rise to these cost differences. This study aimed to estimate the medical costs of beneficiaries with DUDs enrolled in the Medicaid Managed Care (MMC) program in Puerto Rico using claims data.

Efficacy of a Process Improvement Intervention on Inmate Awareness of HIV Services: A Multi-Site Trial.

The prevalence of HIV among U.S. inmates is much greater than in the general population, creating public health concerns and cost issues for the criminal justice system.

Tackling the Health Challenge posed by Hepatitis C in Puerto Rico: A Call for Immediate Public Health Actions.

Within the past decade, researchers and hepatitis C specialists in Puerto Rico have highlighted the burden of hepatitis C and associated disease outcomes in the island to raise public awareness about this problem and set out a call to action to tackle prevention and control efforts, yet so far no concrete actions have taken place. The population-based studies on hepatitis C have documented that the main risk factor is the sharing of syringes and drug paraphernalia to inject drugs, that most seropositive individuals are unaware of their infection status, and that there are large knowledge deficits about the disease, its risk factors, and measures of prevention and control. The subject is further complicated by the fact that despite hepatitis C reporting is mandatory, there is no effective epidemiological surveillance system to provide the information needed for planning, implementation, monitoring, and evaluation of intervention strategies for this infection and access to medical and other existing therapies is limited.

HIV Stigma in Prisons and Jails: Results from a Staff Survey.

With numerous HIV service gaps in prisons and jails, there has been little research on HIV stigma attitudes among correctional staff. Such attitudes may undermine HIV services for inmates at risk of or infected with HIV. This HIV stigma attitudes survey among 218 correctional staff in 32 US facilities (1) provides an overview of staff's stigma attitudes, (2) reports psychometric analyses of domains in Earnshaw and Chaudoir's HIV Stigma Framework (HSF), and (3) explores differences in stigma attitudes among different staff types.

Effects of an Organizational Linkage Intervention on Inter-Organizational Service Coordination Between Probation/Parole Agencies and Community Treatment Providers.

Weak coordination between community correctional agencies and community-based treatment providers is a major barrier to diffusion of medication-assisted treatment (MAT)--the inclusion of medications (e.g., methadone and buprenorphine) in combination with traditional counseling and behavioral therapies to treat substance use disorders.

[Opportunities and methodological challenges in health research in the context of prisons in Puerto Rico].

During 2013 the prison population of Puerto Rico was composed of approximately 13,000 persons. Documents describing the enablers and constraints for research related to mental health in prisons in the existing literature are scarce. The present work consisted of identifying elements that facilitate or hinder research in prisons identified by the members of the research team of a project that aimed to validate a scale to measure stress in prisoners.

Effect of an organizational linkage intervention on staff perceptions of medication-assisted treatment and referral intentions in community corrections.

Introduction: Medication-assisted treatment (MAT) is effective for alcohol and opioid use disorders but it is stigmatized and underutilized in criminal justice settings.

Methods: This study cluster-randomized 20 community corrections sites to determine whether an experimental implementation strategy of training and an organizational linkage intervention improved staff perceptions of MAT and referral intentions more than training alone. The 3-hour training was designed to address deficits in knowledge, perceptions and referral information, and the organizational linkage intervention brought together community corrections and addiction treatment agencies in an interagency strategic planning and implementation process over 12 months.

A cluster randomized trial of an organizational linkage intervention for offenders with substance use disorders: study protocol.

Background: Substance use disorders are highly prevalent in community correctional populations, yet these settings frequently are ill-equipped to identify and refer offenders to community-based treatment services. In particular, community corrections staff are often opposed to the use of medication in addiction treatment because of inadequate knowledge, resources, and organizational structures to facilitate client linkages to evidence-based services.

Methods/design: Each of the NIDA-funded Research Centers recruited 2 criminal justice agencies to participate in the study.

Addressing the HIV/AIDS epidemic among Puerto Rican people who inject drugs: the need for a multiregion approach.

High levels of HIV risk behaviors and prevalence have been reported among Puerto Rican people who inject drugs (PRPWID) since early in the HIV epidemic. Advances in HIV prevention and treatment have reduced HIV among people who inject drugs (PWID) in the United States. We examined HIV-related data for PRPWID in Puerto Rico and the US Northeast to assess whether disparities continue.

Assessing post-traumatic stress symptoms in a Latino prison population.

Purpose: The purpose of this paper is to assess the reliability and validity of the Spanish version of the Davidson trauma scale (DTS-S) and to determine the prevalence and correlates of post-traumatic stress disorder (PTSD) symptoms in a non-clinical random sample of prison inmates.

Design/methodology/approach: Probabilistic samples of 1,179 inmates from 26 penal institutions in Puerto Rico were selected using a multistage sampling design. Population estimates and correlations were obtained for PTSD, generalized anxiety and depression.

Childhood ADHD symptoms are associated with lifetime and current illicit substance-use disorders and in-site health risk behaviors in a representative sample of Latino prison inmates.

Objective: This study aimed to explore retrospective childhood ADHD symptomatology, psychiatric comorbidity, rates of substance-use disorders (SUD), as well as their association with high-risk health behaviors in prison and adverse health outcomes.

Method: A randomly selected representative sample of inmates in the Puerto Rico correctional system (N = 1,179) was assessed with the Spanish-language Wender Utah Rating Scale (WURS); the Composite International Diagnostic Interview (CIDI) modules for lifetime/current major depression disorder (MDD), generalized anxiety disorder (GAD), and SUD; the Davidson Trauma Scale (DTS; posttraumatic stress disorder [PTSD]); and self-reports of in-site high-risk behaviors.

Results: Wald χ(2) tests revealed significant associations of ADHD with MDD and PTSD, as well as increased risk for overdosing and intravenous drug use in prison.