A multicomponent psychosocial intervention to reduce substance use by adolescents involved in the criminal justice system: the RISKIT-CJS RCT.

Background: Substance use and offending are related in the context of other disinhibitory behaviours. Adolescents involved in the criminal justice system constitute a particularly vulnerable group, with a propensity to engage in risky behaviour that has long-term impact on their future health and well-being. Previous research of the RISKIT programme provided evidence of a potential effect in reducing substance use and risky behaviour in adolescents. Objectives: To evaluate the clinical effectiveness and cost-effectiveness of a multicomponent psychosocial intervention compared with treatment as usual in reducing substance use for substance-using adolescents involved in the criminal justice system. Design: A mixed-methods, prospective, pragmatic, two-arm, randomised controlled trial with follow-up at 6 and 12 months post randomisation. Setting: The study was conducted across youth offending teams, pupil referral units and substance misuse teams across four areas of England (i.e. South East, London, North West, North East). Participants: Adolescents aged between 13 and 17 years (inclusive), recruited between September 2017 and June 2020. Interventions: Participants were randomised to treatment as usual or to treatment as usual in addition to the RISKIT-Criminal Justice System (RISKIT-CJS) programme. The RISKIT-CJS programme was a multicomponent intervention and consisted of two individual motivational interviews with a trained youth worker (lasting 45 minutes each) and two group sessions delivered over half a day on consecutive weeks. Main outcome measures: At 12 months, we assessed per cent days abstinent from substance use over the previous 28 days. Secondary outcome measures included well-being, motivational state, situational confidence, quality of life, resource use and fidelity of interventions delivered. Results: A total of 693 adolescents were assessed for eligibility, of whom 505 (73%) consented. Of these, 246 (49%) were allocated to the RISKIT-CJS intervention and 259 (51%) were allocated to treatment as usual only. At month 12, the overall follow-up rate was 57%: 55% in the RISKIT-CJS arm and 59% in the treatment-as-usual arm. At month 12, we observed an increase in per cent days abstinent from substances in both arms of the study, from 61% to 85%, but there was no evidence that the RISKIT-CJS intervention was superior to treatment as usual. A similar pattern was observed for secondary outcomes. The RISKIT-CJS intervention was not found to be any more cost-effective than treatment as usual. The qualitative research indicated that young people were positive about learning new skills and acquiring new knowledge. Although stakeholders considered the intervention worthwhile, they expressed concern that it came too late for the target population. Limitations: Our original aim to collect data on offences was thwarted by the onset of the COVID-19 pandemic, and this affected both the statistical and economic analyses. Although 214 (87%) of the 246 participants allocated to the RISKIT-CJS intervention attended at least one individual face-to-face session, 98 (40%) attended a group session and only 47 (19%) attended all elements of the intervention. Conclusions: The RISKIT-CJS intervention was no more clinically effective or cost-effective than treatment as usual in reducing substance use among adolescents involved in the criminal justice system. Future research: The RISKIT-CJS intervention was considered more acceptable, and adherence was higher, in pupil referral units and substance misuse teams than in youth offending teams. Stakeholders in youth offending teams thought that the intervention was too late in the trajectory for their population. Trial registration: This trial is registered as ISRCTN77037777. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 3. See the NIHR Journals Library website for further project information.

We explored how useful a psychological intervention was in reducing substance use among young people who had some involvement in the criminal justice system. We recruited young people aged between 13 and 17 years in four areas of England (i.e. South East, London, North West and North East). Young people were recruited from youth offending teams, pupil referral units and substance misuse teams. Those young people who were willing to participate were offered usual treatment and half, chosen at random, were offered an opportunity to take part in the RISKIT-Criminal Justice System (RISKIT-CJS) programme. The RISKIT-CJS programme had four distinct parts. The first was a 1-hour session that used an approach called motivational interviewing to explore the young person's substance use and discuss different strategies to change their behaviour. This was followed by two group sessions delivered over 2 consecutive weeks. These group sessions addressed risks associated with substance use, what triggers use and the health and social consequences. In addition, young people were taught new skills to help them manage in situations in which they might normally use substances. At the end of the group sessions, the young people had another motivational interview. Twelve months after participants started, we found that the frequency of substance use had decreased in both groups; however, the RISKIT-CJS intervention was no better than treatment as usual. When we spoke with young people who had taken part and staff involved with this population, we got a mixed picture. In some settings, particularly pupil referral units, the RISKIT-CJS intervention was well received by young people and staff, and staff felt that it was a useful additional resource to the work that they were currently undertaking. On the other hand, in the youth offending teams, the staff thought that the programme was too different from their normal work to be implemented easily and they considered the population they work with too established in their substance use and criminal activity to benefit from the programme.

The impact of Covid-19 pandemic on overall well-being of practicing lawyers.

Every day lawyers provide counsel and advocacy to individuals, groups, and businesses in a multitude of settings. From court room to board room, attorneys are relied upon to guide their clients through difficult situations. In doing this, attorneys all too often internalize the stresses of those that they help. The legal system has long been considered a stressful occupation. This stressful environment was further taxed by the wider societal disruptions in 2020 as we dealt with the onset of the COVID-19 pandemic. Beyond the illness itself, the pandemic forced widespread court closures and made it more difficult to communicate with clients. Based upon a survey of the membership of the Kentucky Bar Association, this paper considers the impact of the pandemic on attorney wellness in a variety of categories. These results demonstrated marked negative impacts on a variety of wellness measures which may result in significant reductions in service provision and efficacy for the people who need legal services. The pandemic made the practice of law harder and more stressful. Attorneys suffered increased incidence of substance abuse, alcohol consumption, and stress during the pandemic. These results were generally worse among those practicing in the areas of criminal law. In light of these adverse psychological effects facing attorneys, the authors argue the need for increased mental health support resources for attorneys, as well as establishing clear steps to raise awareness among the legal community about the importance of mental health and personal wellness.

Experience delivering an integrated service model to people with criminal justice system involvement and housing insecurity.

BACKGROUND: People returning to communities from prison or jail face stressors related to securing housing, including discrimination, restrictions based on prior felony convictions, and limited economic and social resources. Existing housing programs can effectively reduce housing instability but often do not fully address the needs of people involved in the criminal justice system experiencing homelessness who often have co-occurring chronic medical issues, and psychiatric and substance use disorders. METHODS: Project CHANGE is an ongoing program to deliver person-centered, integrated care and services to individuals involved with the criminal justice system and experiencing homelessness. Applying a Screening, Brief Intervention, (Referral to) Treatment framework, a comprehensive needs assessment is followed by delivery of intensive housing and vocational case management; and psychiatric, substance use, and medical services in a single location by an interdisciplinary team. Participants are followed with study interviews for 12 months. The current analysis was designed to assess the baseline characteristics and needs of the sample population, and the intensity of contact required for integrated service delivery. RESULTS: Between November 2019 and September 2021, 86 participants were enrolled, of whom 64% had been released from prison/jail in the past 6 months; the remainder were on parole, probation, or intensive pretrial supervision. Participants were unstably housed (64%) or residing outdoors (26.7%) or in a shelter (24.4%). Most participants had high medical need and frequent healthcare engagement through outpatient and emergency department visits. Most participants were at-risk for clinical depression, and half were diagnosed with anxiety, dissociative, stress-related, somatoform, and other non-psychotic psychiatric disorders. Over 12-month follow-up, the interdisciplinary team made over 500 contact encounters, over half of which resulted in direct services provided, including obtaining vital documents for homelessness verification, housing applications, and employment coaching. CONCLUSION: Navigation of services can be particularly challenging for individuals experiencing criminal justice involvement, homelessness, and co-occurring medical, psychiatric, and substance use issues, which can be addressed holistically in an integrated service model. Integrated service delivery was time-, resource-, and staffing-intensive, and challenged by the COVID-19 pandemic, requiring innovative solutions to sustain participant engagement.

Psychological services to extend public health and disease management approaches in criminal justice settings: An introduction.

COVID-19 has brought renewed attention to the physical and mental health needs of underserved populations and the settings that assist them in receiving services. This introduction presents six articles of a special section on disease management approaches used within criminal justice settings to address such needs. Articles span a range of settings, including prisons, jails, mental health courts, forensic settings, and crisis units. Collectively, the articles in this special section discuss medical conditions, substance use, and mental health. They provide information on the diverse approaches taken across various settings in managing the physical and mental health challenges of those involved in the criminal justice system. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Public Health Risk and Civic Peership.

During the COVID-19 pandemic, some US federal courts required jurors' vaccination against COVID-19, which, according to some, made a juror less representative of a peer. This comic investigates this set of concerns narratively and visually.

Intersectoral violence prevention: the potential of public health-criminal justice partnerships.

Building successful intersectoral partnerships to address health is critical to reaching health promotion goals. With the confluence of the COVID-19 pandemic, the increase in violence during the pandemic and the heightened demand for racial justice resulting from police killings of people of color, particularly young, black males, intersectoral public health-criminal justice partnerships must be more thoroughly examined. Violence prevention is both a public health and criminal justice issue, with public health systems emphasizing primary prevention and criminal justice systems addressing violence prevention at secondary and tertiary levels. Public health-criminal justice collaborations can provide an opportunity to seize upon unrealized violence reduction goals across the spectrum of prevention. At the same time, issues remain that are at odds across field boundaries as exemplified through community violence prevention. While there have been successful examples of such collaborations, past public health-criminal justice partnerships also demonstrate the challenges of working together. These challenges have yet to be systematically described and rooted in the larger literature on partnerships. In this paper, collaborative challenges are enumerated and evidence-informed strategies to overcome those barriers to achieve violence reduction goals are identified as a way to ground further intersectoral partnership work between public health and criminal justice.

Low Threshold Telemedicine-based Opioid Treatment for Criminal Justice Involved Adults During the COVID-19 Pandemic: A Case Report.

Criminal justice involved individuals have a high rate of opioid overdose death following release. In March 2020, New York City jails released over 1000 inmates due to concern of COVID-19 outbreaks in county jails. The closure of addiction treatment clinics further complicated efforts to expand access to medications for opioid use disorder among criminal justice involved adults. The New York City Health + Hospitals Virtual Buprenorphine Clinic established in March 2020 offered low-threshold telemedicine-based opioid treatment with buprenorphine-naloxone, specifically for criminal justice involved adults post-release. We describe a case report of the novel role of tele-conferencing for the provision of buprenorphine-naloxone for jail-released adults with opioid use disorder experiencing homelessness during the COVID-19 pandemic. The patient is a 49-year-old male with severe opioid use disorder released from New York City jail as part of its early release program. He then started using diverted buprenorphine-naloxone, and 1 month later a harm-reduction specialist at his temporary housing at a hotel referred him to an affiliated buprenorphine provider and then eventually to the New York City Health + Hospitals Virtual Buprenorphine Clinic, where he was continued on buprenorphine-naloxone, and was followed biweekly thereafter until being referred to an office-based opioid treatment program. For this patient, telemedicine-based opioid treatment offered a safe and feasible approach to accessing medication for opioid use disorder during the COVID-19 pandemic and following incarceration.

The Importance of Criminal Justice Health Education for Today's Medical Students and Strategies for Integration Into Medical School Curricula.

As the United States wrestles with the consequences of the COVID-19 pandemic and concurrently confronts long-standing issues of racial injustice, it is more important than ever that criminal justice health becomes an integrated component of medical school curricula. Nearly all future physicians will someday be caring for justice-involved patients or their family members. A foundational medical school education that includes criminal justice health will better equip these physicians to not only care for their patients, but also help address health care disparities and the public health concerns that affect our communities. These recommended changes to U.S. medical school curricula will occur only with the commitment of academic leaders and their inclusion of medical school faculty with criminal justice health expertise to help guide these efforts. Now is the time for U.S. medical schools to embrace criminal justice health as essential learning.

Judicial judgment and media sensation of violence against medical staff in China: A fuzzy set qualitative comparative analysis (fsQCA).

INTRODUCTION: Violence against medical staff has been prevalent in China over the past two decades. Although Chinese authorities have released many laws and regulations to protect medical staff from violence since 2011, the legal approach alone is unlikely to resolve this complex issue. In particular, several cases of violence against medical staff in China have caused great media sensation. METHOD: This paper proposes an integrated model that combines the environmental stimuli theory, broken windows theory, and rational choice theory. It adopts the fuzzy set qualitative comparative analysis (fsQCA) to untangle the causal relationship between violence against medical staff, media sensation, and judicial judgment. We examined reports of medical violence on media and news websites from January 1, 2010, to January 31, 2020, and selected 50 cases with detailed information for this study. RESULTS: The results show that each condition is not sufficient for the absence of judicial judgment, but when combined, they are conducive to the outcome. The conditions of hospital level, medical cost, and media sensation play important roles. The providers, patients, and environmental factors are indicators of inadequate or lack of judicial judgment, which corresponds to previous expectations. CONCLUSIONS: The integrated model greatly enriches the extant theories and literature, and also yields implications for preventing violence against medical staff in China. We suggest that sustainable and innovative healthcare reform should be initiated. For example, public hospitals should remain the cornerstone of national public health security. Medical staff in public hospitals must be regarded as "civil servants". Therefore, the current legal system should be improved. The media should objectively report events concerning medical staff and improve public healthcare knowledge.

Wildlife must be protected from crime and trade for the sake of public and planetary health.

COVID-19 most likely had its origins in wildlife, and hundreds of thousands of new viruses could spill over from wildlife to humans. We are struggling to combat climate change, and we are staring down the loss of a million species. It's time to change course.

Tele-forensic interviewing can be a reasonable alternative to face-to-face interviewing of child witnesses.

OBJECTIVE: Tele-forensic interviews have the potential to aid investigations when children live far from interviewers, there is a risk of disease transmission, or when expertise is not locally available. However, it is unknown whether tele-forensic interviewing is an effective alternative to face-to-face interviewing, particularly for children most prone to suggestibility and lapses of attention. HYPOTHESES: Previous studies suggested that school-age children would provide similar amounts of information across interview modes but provided no basis for predicting how misinformation impacts accuracy across modes or how 4- and 5-year-olds would react to tele-forensic interviewing. METHOD: Children (4-8 years, N = 261, Mage = 6.42 years, 48% female) interacted with male assistants who violated a no-touching rule, parents read children a book containing misinformation about that event, and female assistants conducted interviews (usually 2 weeks after the event) face-to-face or via a video conference application. RESULTS: The children were more talkative during a practice narrative phase when interviewed face-to-face rather than on screen (incidence rate ratio [IRR] = 1.26, 95% CI [1.06, 1.51]), and 4-, 5-, and 6-year-olds said more in response to open-ended prompts when interviewed face-to-face (IRR = 1.50, 95% CI [1.08, 2.09]). Children younger than 7 years also disclosed the face touch and noncompleted handshake in response to earlier and less directive prompts when interviewed face-to-face, rs(53) = .28, p = .037, and rs(48) = .33, p = .021, respectively. Children 8 years and older, however, disclosed the face touch more readily when they spoke on screen, rs(28) = -.38, p = .036, and older 7-year-olds and 8-year-olds disclosed the noncompleted handshake more readily on screen, rs(30) = -.36, p = .042. Across interview modes, children reported comparable numbers of touch events, however, and were equally accurate on challenging source-monitoring and detail questions. CONCLUSIONS: Tele-forensic interviewing can be a reasonable alternative to face-to-face interviewing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Innocence in the shadow of COVID-19: Plea decision making during a pandemic.

Over 95% of criminal convictions in the United States are the result of guilty pleas. Consequently, it is critical that we ensure the process of pleading guilty is as free of coercion as possible. Yet, research has indicated that incarcerating defendants to await trial could have an undue influence on their decision to plead guilty. The current research employed a novel computer simulation to examine the impact of the COVID-19 pandemic on plea decision making among the innocent and the guilty when faced with potential pretrial detention. While presenting COVID-related information to participants increased both true and false guilty pleas, further analyses indicated that concerns about COVID-19 weighed more heavily on the innocent than the guilty. These findings illustrate the negative impact a pandemic could have in combination with a system of pleas that often allows prosecutors to provide defendants with just one guaranteed respite from jail-a guilty plea. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

COVID-19 exacerbates existing system factors that disadvantage defendants: Findings from a national survey of defense attorneys.

OBJECTIVE: COVID-19 has impacted many facets of daily life and the legal system is no exception. Legal scholars have hypothesized that the effects of the pandemic may contribute to more coercive plea bargains (Cannon, 2020; Johnson, 2020). In this study, we explored defense attorneys' perceptions of whether and how the plea process has changed during the COVID-19 pandemic. HYPOTHESES: This study was exploratory, and we made no a priori hypotheses. METHOD: We surveyed 93 practicing United States defense attorneys about their perceptions of whether and how the pandemic has affected court procedures, plea-bargaining and prosecutorial behavior, and defendant decision-making. We conducted semistructured follow-up interviews with 13 defense attorneys to help contextualize the survey responses. RESULTS: The majority of defense attorneys (81%, n = 76) reported that the plea process had changed during the COVID-19 pandemic, and that they experienced difficulty contacting and communicating with their clients, especially those who were detained. Two thirds of defense attorneys (n = 42) who said the plea process had changed thought that prosecutors were offering more lenient deals. One third of defense attorneys with detained clients (n = 23) reported having had clients plead guilty due to COVID-19 related conditions who might not have under normal circumstances. CONCLUSIONS: The majority of defense attorneys reported that the COVID-19 pandemic has impacted their ability to access and advise clients, and they believed that leverage in plea negotiations had shifted further to individual prosecutors. At the same time, the attorneys reported that prosecutors were offering more lenient deals, painting a complex picture of the plea negotiation process during the pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).