Human Trafficking in Correctional Institutions: A Survey of Correctional and Anti-Trafficking Leaders.

Growing awareness of the overlap between justice involvement and human trafficking victimization has led to calls for correctional institutions to prevent, identify, and respond to trafficking. However, it is unclear how correctional facilities (i.e., jails and prisons) are responding to such calls to action. To examine current efforts to address human trafficking in U.S. correctional facilities, this study surveyed correctional and anti-trafficking leaders (n = 46) about their perceptions and experiences with human trafficking screening, response, and training in correctional facilities. Although the majority of leaders (89%) agreed individuals in their state's correctional facilities have experienced human trafficking, they generally did not perceive that correctional staff were prepared to respond. Bivariate tests revealed that correctional and anti-trafficking leaders differed on their perceptions regarding correctional staffs' knowledge about human trafficking risk factors (p = .014), identification ability (p = .006), and response knowledge (p = .036), with anti-trafficking leaders perceiving correctional staff to be less prepared in these areas. Approximately 16% of leaders reported strategies to identify and respond to trafficking in correctional facilities, and about 27% reported human trafficking training for corrections staff. To promote a just society, study findings offer preliminary guidance for anti-trafficking correctional initiatives and future research.

A Systematic Review of Conceptualizations and Operationalizations of Youth Polyvictimization.

Violence against youth is a global issue impacting millions each year. Increasingly, research has focused on studying those impacted by multiple forms of violence, or polyvictims. Evidence strongly suggests that polyvictimized youth tend to have worse physical and mental health outcomes than those who have experienced single forms of violence. Moreover, minoritized youth (i.e., racial and/or sexual minority youth, youth with disabilities) are more likely to experience polyvictimization, making this a social justice and equity concern. To date, there is no universal consensus on what exactly constitutes polyvictimization. This systematic review aims to examine the ways in which polyvictimization is being studied to inform both research and practice. As such, relevant databases were searched to amass the extant literature related to youth polyvictimization internationally. Empirical studies published since 2006 that focused on youth (under age 18) polyvictimization were included. After the review process, 264 studies met eligibility criteria, however 55 studies employed person-centered/finite mixture analyses and were removed for a separate review, resulting in 209 featured in the current systematic review. Results demonstrate that researchers are defining and operationalizing polyvictimization in different ways: (a) using individual victimization event counts; (b) employing domain-based counts; and (c) taking a "highest-victimized" percentage of their sample. The most used measurement tool was the Juvenile Victimization Questionnaire, though other validated tools and researcher-constructed questions were frequently utilized. Research on polyvictimization is burgeoning worldwide; however, this research is being conducted in disparate ways, making it difficult to compare findings and further advance the field.

A National Typology of Health Service Regulation in Assisted Living.

BACKGROUND AND OBJECTIVES: State-regulating agencies use 350 different licenses and certifications to govern assisted living (AL), resulting in significant variation in regulations governing health services, the scope of practice, and capacity. This lack of standardization makes it difficult to compare and contrast AL operations and residents' outcomes across similarly regulated communities. RESEARCH DESIGN AND METHODS: We used qualitative and quantitative methods to empirically develop and describe a typology of state AL regulations that captures inter- and intrastate variation. Based on the rules governing health services, we created regulatory specificity scores for 5 thematic dimensions: medication administration, third-party care, skilled nursing, medication review, and licensed nurse staffing. With these scores, we conducted a K-means cluster analysis to identify groups of AL license types. To differentiate the regulatory types, we calculated standardized mean differences across structure, process, outcome, and resident characteristics of the AL communities licensed under each type. RESULTS: We identified 6 types of AL differentiated by the regulatory provisions governing health services: Housing, Holistic, Hybrid, Hospitality, Healthcare, and Health Support. The types align with previous work and reflect tangible differences in resident characteristics, health service structures, processes, and outcomes. DISCUSSION AND IMPLICATIONS: This typology effectively captures differences across regulated dimensions and can inform and support quality of care. Researchers, policy-makers, and consumers may benefit from using this typology and acknowledging these differences in AL licensure when designing research studies, developing policies, and selecting an AL community.

Commentary: On measurement error, PSA doubling time, and prostate cancer.

Exposure measurement error is a pervasive problem for epidemiology research projects designed to provide valid and precise statistical evidence supporting postulated exposure-disease relationships of interest. The purpose of this commentary is to highlight an important real-life example of this exposure measurement error problem and to provide a simple and useful diagnostic tool for physicians and their patients that corrects for the exposure measurement error. More specifically, prostate-specific antigen doubling time (PSADT) is a widely used measure for guiding future treatment options for patients with biochemically recurrent prostate cancer. Numerous papers have been published claiming that a low calculated PSADT value (denoted PSADT^) is predictive of metastasis and premature death from prostate cancer. Unfortunately, none of these papers have adjusted for the measurement error in PSADT^, an estimator that is typically computed using the popular Memorial Sloan Kettering website very often visited by both physicians and their patients. For this website, the estimator PSADT^ of the true (but unknown) PSADT for a patient (denoted PSADT∗) is computed as the natural log of 2 (i.e., 0.6931) divided by the estimated slope of the straight-line regression of the natural log of PSA (in ng/mL) on time. We utilize PSADT^ to derive an expression for the probability that the unknown PSADT∗ for a patient is below a specified value C (>0) of concern to both the physician and the patient. This probability is easy to interpret and takes into account the fact that PSADT^ is a statistical estimator with variability. This variability introduces measurement error, namely, the difference between a computed value PSADT^ and the true, but unknown, value PSADT∗. We have developed an Excel calculator that, once the [time, ln(PSA)] values are entered, outputs both the value of PSADT^ and the desired probability. In addition, we discuss problematic statistical issues attendant with PSADT∗ estimation typically based on at most three or four PSA values. We strongly recommend the use of this probability when physicians are discussing PSADT^ values and associated treatment options with their patients. And, we stress that future epidemiology research projects involving PSA doubling time should take into account the measurement error problem highlighted in this Commentary.

Exploring Perceived Legal and Organizational Support and Attitudes on the Decision to Mediate or Arrest in Domestic Violence Cases: A Study Among Community and Criminal Justice Professionals in China.

This study investigates factors related to the decision to (a) arrest or (b) mediate in domestic violence (DV) situations-nonmutually exclusive but highly differing decisions chosen a priori as being outcomes of interest. The sample included three types of professionals handling domestic violence cases in China: (a) Women's Federation (WF), (b) police, and (c) judicial personnel. The participants (n = 817) responded to a vignette describing a DV incident. Logistic regression revealed that legal, organizational, and attitudinal factors were associated with decision-making and varied by group. The findings suggest training and detailed instructions on handling DV.

Characteristics of and Circumstances Associated With Female Intimate Partner Problem-Included Suicides: Analysis of Data From the National Violent Death Reporting System (2003-2019).

Intimate partner problems (IPP)-which include divorce, breakups, arguments, jealousy, conflict, discord, and violence-have been robust precipitating factors associated with an increased risk for suicidal thoughts and behaviors. Although research on suicide related to IPP is growing, efforts to explore the circumstances surrounding suicidality among female victims struggling with IPP remain insufficient. To address this gap, this exploratory study sought to understand the circumstances surrounding female IPP-related suicide in the United States. We conducted a secondary analysis of data from the U.S. National Violent Death Reporting System (NVDRS, 2003-2019) which includes 43 states, the District of Columbia, and Puerto Rico. Of the final analytical sample of 58,545 female suicide cases in the United States, we delineated IPP-included suicide cases (13,496, 23.1%) and non-IPP-included suicide cases (45,049, 76.9%). Two-sided Pearson chi-square tests and standardized difference (SD) tests identified significant differences in the surrounding circumstances between IPP-included suicide and non-IPP-included suicide. IPP-included female suicide was more common among younger women, those involved in an intimate relationship, and women who were pregnant or postpartum (p < .001; SD > .10). IPP-included suicide victims were more likely to have experienced depression, substance abuse, and previous interpersonal trauma than non-IPP-included suicide victims (p < .001; SD > .10). Compared to non-IPP-included suicide, IPP-included suicide was more likely to occur at the victim's house or apartment during evening and nighttime by firearm or hanging (p < .001; SD > .10). Our findings also showed that IPP-included suicide victims had previous suicidal thoughts and were more likely to have disclosed their suicidal ideation with others before committing suicide than non-IPP-included suicide victims (p < .001; SD > .10). Findings identified unique circumstances and characteristics possibly associated with IPP-included female suicide. Our understanding of suicide may be enhanced by exploring the causal pathway behind these relationships.

A Scoping Review of Human Trafficking Screening and Response.

Service providers are increasingly asked to identify individuals who are experiencing trafficking and to connect them with resources and support. Nonetheless, identification is complicated by the reality that those who are experiencing trafficking may rarely self-identify, and providers may fail to identify individuals who are experiencing trafficking due to lack of guidance on how to screen for trafficking capably and sensitively. With the aim of guiding practice, we undertook a scoping review to search for and synthesize trafficking screening tools and response protocols. Following the PRISMA extension for Scoping Reviews (PRISMA-ScR), we located 22 screening tools contained in 26 sources. We included any documents that described or tested human trafficking screening tools, screening or identification protocols, response protocols, or guidelines that were published in any year. All documents were abstracted using a standardized form. Key findings showed that most tools were developed by practice-based and non-governmental organizations located in the U.S. and were administered in the U.S. Few screening tools have been rigorously evaluated. The common types of screening questions and prompts included (a) work conditions; (b) living conditions; (c) physical health; (d) travel, immigration, and movement; (e) appearance and presentation; (f) mental health, trauma, and substance abuse; (g) associations and possessions; and (h) arrests and prior involvement with law enforcement. We were not able to locate specific response protocols that provided step-by-step guidance. Nonetheless, the review revealed available practice-based and research-based evidence to help inform guidance concerning how screening and identification of human trafficking may be administered.

Patient-level information underlying overdiagnosis of urinary tract infections in nursing homes: A discrete choice experiment.

The overdiagnosis of urinary tract infections (UTIs) in nursing home residents is a significant public health threat. Using a discrete choice experiment and a diagnostic guideline, we examined which patient-level information was associated with the overdiagnosis of UTIs and found that urinalysis results and lower urinary tract status were most associated.

Understanding Intimate Partner Violence Service Delivery for Latinx Survivors in Rural Areas.

Using a statewide survey, this exploratory, cross-sectional study examined 78 domestic violence (DV) service organizations' service delivery practices and perceived challenges to serving Latinx survivors in the context of rurality. Findings showed that DV organizations in rural areas perceived more challenges to delivering culturally appropriate services for Latinx survivors compared to those in other geographic settings even after accounting for client characteristics, service provision characteristics, and community resources. The study finding offers critical insights to ensure and enhance the provision of linguistically and culturally accessible services for rural Latinx survivors of intimate partner violence.

Recommendations for Medical and Mental Health Care in Assisted Living Based on an Expert Delphi Consensus Panel: A Consensus Statement.

Importance: Assisted living (AL) is the largest provider of residential long-term care in the US, and the morbidity of AL residents has been rising. However, AL is not a health care setting, and concern has been growing about residents' medical and mental health needs. No guidance exists to inform this care. Objective: To identify consensus recommendations for medical and mental health care in AL and determine whether they are pragmatic. Evidence Review: A Delphi consensus statement study was conducted in 2021; as a separate effort, the extent to which the recommendations are reflected in practice was examined in data obtained from 2016 to 2021 (prepandemic). In the separate effort, data were from a 7-state study (Arkansas, Louisiana, New Jersey, New York, Oklahoma, Pennsylvania, Texas). The 19 Delphi panelists constituted nationally recognized experts in medical, nursing, and mental health needs of and care for older adults; dementia care; and AL and long-term care management, advocacy, regulation, and education. One invitee was unavailable and nominated an alternate. The primary outcome was identification of recommended practices based on consensus ratings of importance. Panelists rated 183 items regarding importance to care quality and feasibility. Findings: Consensus identified 43 recommendations in the areas of staff and staff training, nursing and related services, resident assessment and care planning, policies and practices, and medical and mental health clinicians and care. To determine the pragmatism of the recommendations, their prevalence was examined in the 7-state study and found that most were in practice. The items reflected the tenets of AL, the role of AL in providing dementia care, the need for pragmatism due to the diversity of AL, and workforce needs. Conclusions and Relevance: In this consensus statement, 43 recommendations important to medical and mental health care in AL were delineated that are highly pragmatic as a guide for practice and policy.

Dementia and COVID-19 infection control in assisted living in seven states.

BACKGROUND: Assisted living (AL) is the largest residential long-term care provider in the United States, including for persons with Alzheimer's disease and related dementias. Despite recognizing the challenge of infection control for persons with dementia, this study of 119 AL communities is the first to describe dementia-relevant COVID-19 infection control across different types of AL communities, and to discuss implications for the future. METHODS: From a parent study sampling frame of 244 AL communities across seven states, 119 administrators provided data about COVID-19 infection control practices and resident behaviors. Data were collected from July 2020 through September 2021. Communities were differentiated based on the presence of beds/units dedicated for persons living with dementia, as being either dementia-specific, mixed, or integrated. Data obtained from administrators related to feasibility of implementing seven infection control practices, and the extent to which residents themselves practiced infection prevention. Analyses compared practices across the three community types. RESULTS: Less than half of administrators found it feasible to close indoor common areas, all community types reported a challenge organizing group activities for safe distancing, and more than half of residents with dementia did not wear a face covering or maintain physical distance from other residents when indicated. Dementia-specific AL communities were generally the most challenged with infection control during COVID-19. CONCLUSION: All AL community types experienced infection control challenges, more so in dementia-specific communities (which generally provide care to persons with more advanced dementia and have fewer private beds). Results indicate a need to bolster infection prevention capacity when caring for this especially vulnerable population, and have implications for care in nursing homes as well.

Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline.

PURPOSE: To inform overprescribing and antibiotic stewardship in nursing homes (NHs), we examined the concordance between clinicians' (NH primary care providers and registered nurses) diagnosis of suspected UTI with a clinical guideline treated as the gold standard, and whether clinician characteristics were associated with diagnostic classification. METHODS: We conducted a cross-sectional web-based survey of a U.S. national convenience sample of NH clinicians. The survey included a discrete choice experiment with 19 randomly selected clinical scenarios of NH residents with possible UTIs. For each scenario, participants were asked if they thought a UTI was likely. Responses were compared to the guideline to determine the sensitivity and specificity of clinician judgment and performance indicators. Multivariable logistic mixed effects regression analysis of demographic, work, personality, and UTI knowledge/attitudes characteristics was conducted. RESULTS: One thousand seven hundred forty-eight NH clinicians responded to 33,212 discrete choice scenarios; 867 (50%) were NH primary care providers and 881 (50%) were NH registered nurses, 39% were male, and the mean age was 45 years. Participants were uncertain about diagnosis in 30% of scenarios. Correct classification occurred for 66% of all scenarios (providers: 70%; nurses: 62%). Respondent judgment had a sensitivity of 78% (providers: 81%; nurses: 74%) and specificity of 54% (providers: 59%; nurses: 49%) compared to the clinical guideline. Adjusting for covariates in multivariable models, being a nurse and having higher closemindedness were associated higher odds of false positive UTI (odds ratio [OR] 1.61, p < 0.001; and OR 1.09, p = 0.039, respectively), although higher UTI knowledge and conscientiousness were associated with lower odds of false positive UTI ratings (OR 0.80, p < 0.001; OR 0.90, p = 0.005, respectively). CONCLUSIONS: Clinicians tend to over-diagnose urinary tract infections, necessitating systems-based interventions to augment clinical decision-making. Clinician type, UTI knowledge, and personality traits may also influence behavior and deserve further study.

Melatonin Prescribing in Assisted Living.

OBJECTIVES: Aging is associated with sleep problems, which are common among assisted living (AL) residents. More than 40% of residents have insomnia, and almost 70% have a sleep disturbance of some kind. Melatonin to treat sleep disorders has become common among older adults, but its use in AL is unknown, which is concerning because melatonin may have side effects and interfere with other medications. The purpose of this study was to determine the prevalence and correlates of melatonin prescribing in AL, to inform whether changes in care may be indicated. DESIGN: Cross-sectional chart abstracts and interviews. SETTINGS AND PARTICIPANTS: Data were collected in 250 randomly selected AL communities among 5777 residents across 7 states in the United States and weighted to an estimated 4043 communities and 152,719 residents. METHODS: Charts of residents were abstracted, and AL administrators and health care supervisors were interviewed to obtain information related to case-mix, staffing, and attitudes regarding psychoactive medications. Weighted analyses primarily examined the association of melatonin prescribing with community- and resident-level characteristics. RESULTS: Melatonin was prescribed in 82% of communities, more commonly in those that had a registered nurse or licensed practical nurse on site (+7%, P = .027), and whose health care supervisor was more favorable toward nonpharmacologic practices (+18%, P = .010). On average, 9% of residents were prescribed melatonin, with prescriptions being more common among those diagnosed with dementia (+24%, P = .004); a psychiatric disorder, especially an anxiety disorder (+43%, P = .007); having behavioral expressions; and taking other psychotropics. Coprescribing was common, especially with antidepressants (OR 2.64, 95% CI 1.99, 3.48; P < .001). CONCLUSIONS AND IMPLICATIONS: This study is the first to examine melatonin prescribing in AL, and finds it to be common. Such use may be appropriate if it is as a more suitable replacement for hypnotics. The fact that use varies by organizational characteristics suggests practices may be modifiable. Research examining benefits and side effects of melatonin, overall and in relation to other medications, is indicated to promote better care for AL residents.

Potential Side Effects and Adverse Events of Antipsychotic Use for Residents With Dementia in Assisted Living: Implications for Prescribers, Staff, and Families.

Antipsychotic medications are frequently prescribed to assisted living (AL) residents who have dementia, although there is a lack of information about the potential side effects and adverse events of these medications among this population. Oversight and monitoring by family members is an important component of AL care, and it is important to understand family awareness of antipsychotic use and reports of potential side effects and adverse events. This cross-sectional, descriptive study of family members of 283 residents with dementia receiving antipsychotic medications in 91 AL communities found high rates (93%) of symptoms that could be potential side effects and a 6% rate of potential adverse events. The majority of families were aware their relative was taking an antipsychotic. Findings suggest that obtaining family perspectives of potential side effects and adverse events related to medication use may contribute to overall improvement in the safety of AL residents living with dementia.

Measuring the Cultural Competence of Latinx Domestic Violence Service Organizations.

Domestic violence (DV) represents a significant public health concern in the United States, including among Latinx populations. Despite the negative consequences associated with experiencing DV, research has shown that Latinx DV survivors may be less likely than others to utilize important services. One potential barrier is cultural competence (CC) in the provision of services specific to Latinx survivors among DV organizations. Thus, a beneficial addition to the field of DV service provision for such survivors is a better understanding and measurement of CC for this unique population. The exploratory, cross-sectional study herein presents the development and evaluation of a novel instrument for measuring the CC of DV organizations. Exploratory factor analysis was used on a purposive sample of 76 organizations in North Carolina who completed a comprehensive survey on their characteristics, practices, norms, and values. Psychometric results found best support for a 29-item, 4-factor bifactor model with both a general CC factor as well as three sub-factors. The general scale was named "General Cultural Competence," while the three sub-scales were named "Organizational Values and Procedures," "Latinx Knowledge and Inclusion," and "Latinx DV Knowledge." The final measure also demonstrated convergent validity with key organizational characteristics. Overall, higher CC scores were associated with organizations having more DV services in Spanish, a higher percentage of staff attending CC training, a higher percentage of staff attending Latinx service provision training, and a medium or greater presence in the Latinx community, and a moderate or stronger relationship with the Latinx community. The development of this measure is particularly useful in addressing knowledge gaps regarding the measurement of CC for Latinx DV services. Implications have importance for both the measurement of organizational CC and the scope of the measure's associations with organizational, provider, and client outcomes.

As-Needed Prescribing and Administration of Psychotropic Medications in Assisted Living: A 7-State Study.

OBJECTIVES: Psychotropic medications administered on an as-needed basis, often designated as pro re nata (or PRN, hereafter as-needed), can alleviate acute symptoms and facilitate deprescribing, although as-needed use is associated with negative outcomes such as polypharmacy and drug interactions. The aim of this study was to examine the extent to which PRN psychotropic medications are prescribed and administered to assisted living (AL) residents, overall and in relation to resident- and community-level characteristics. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: All AL residents and select staff in 250 AL communities in 7 states. METHODS: Data regarding prescribing and administration of 5 types of PRN psychotropic medications in the prior 7 days (antipsychotics, mood stabilizers and antiepileptics, antidepressants, anxiolytics/hypnotics, and cognitive enhancers) were abstracted and compared across resident and community characteristics. RESULTS: Prescribing of PRN psychotropics in AL is low (10.3%). Of prescribed PRN medications, 2.5% of residents were administered a PRN and 8% had PRN that was not administered in the previous 7 days. Anxiolytics were administered PRN more commonly compared with antipsychotics (2.0% vs 0.2%). Of all PRN psychotropic prescriptions (n = 1039), 70.5% had a written indication describing the reason for administration. Among PRN medications administered (n = 242), the proportion with an indication was lower (62.0%). PRN psychotropic medication prescribing was higher among residents with dementia and a psychiatric diagnosis, and in larger AL communities and those with a higher proportion of dementia care beds. CONCLUSIONS AND IMPLICATIONS: The prescribing and administration of PRN psychotropic medications in AL is relatively rare, although more common among residents with dementia. Emerging psychotropic medication policies should be expanded to address mental health care, anxiolytic/hypnotic use for residents living with dementia, PRN prescribing in chart review, and the use of detailed indications for PRN use, especially when medications are administered by unlicensed care staff.

Study protocol for an evaluability assessment of an anti-human trafficking program.

BACKGROUND: Human trafficking is a serious global challenge associated with a complex array of health inequities for individuals, families, and communities. Consequently, in addition to a conventional criminal justice approach, anti-trafficking scholars have increasingly called for a public health approach to address this global challenge. Such calls have emphasized that a comprehensive, robust, and social justice-informed public health strategy for anti-trafficking must include services to facilitate survivors' HT exit and recovery, and to prevent their re-victimization. Fortunately, many community-based organizations and non-governmental organizations worldwide have heeded these calls and developed anti-trafficking programs for survivors. Unfortunately, despite the growing numbers of organizations providing anti-trafficking services, research concerning these programs' effectiveness remains nascent overall, and even more scant when filtered through an equity focus. METHODS: To advance the field by developing guidance concerning how best to evaluate anti-human trafficking programs, an ongoing research project aims to conduct a mixed methods evaluability assessment of a prominent anti-trafficking program using a social justice framework. Guided by well-established evaluability assessment frameworks, the study activities include four sequential steps: (a) focusing the assessment, (b) developing the program theory and logic, (c) gathering feedback, and (d) applying the assessment findings. Activities will include qualitative interviews and focus groups, observations, and quantitative analysis of program data among others. Human subjects and ethical review for the evaluability assessment has been granted by the Office of Human Subjects Research at The University of North Carolina at Chapel Hill. DISCUSSION: Once completed, evaluability assessment results will provide evidence and products that have the potential to guide both evaluation research and service provision not only for the specific organization under study, but also for other anti-human trafficking programs worldwide. Findings will be developed into a variety of dissemination products tailored for both practice professionals and researchers. In the interim, this protocol manuscript offers research strategies and recommendations that can help inform the development of other studies in the developing field of anti-trafficking program evaluation research.

Certified nursing assistants' experiences with self-compassion training in the nursing home setting.

Certified nursing assistants (CNAs) in nursing home (NH) settings experience considerable work-related and personal stress. Self-compassion is a personal resource linked to improved stress coping and may be particularly relevant to health care workers. In this study, we explored NH CNA's experiences with self-compassion training based on their narrative replies. Twenty-two CNAs (100% female, mean age 48 years, 82% Black/African American) from 3 mid-sized, non-profit NHs in the Southeast US completed either a standard 8-week, 20 h self-compassion training or a 6-week, 6 h modified version designed for health care providers. Qualitative data analyses from post-training focus group discussions identified four themes pertaining to changes in: (1) stress management, (2) appreciation and support, (3) caregiver role, and (4) connection to others. Findings suggested self-compassion training is feasible and beneficial for the stressors that CNAs experience. In the era of COVID-19 and beyond, self-compassion training is a promising method to improve CNAs' well-being.