Efficacy of Structured Organizational Change Intervention on HIV Testing in Correctional Facilities.

This article presents findings from a multisite cluster randomized trial of a structured organizational change intervention for improving HIV testing services in jails and prisons. Matched pairs of prison and jail facilities were randomized to experimental and control conditions; all facilities received baseline training about best practices in HIV testing and other HIV services and selected an area of HIV services on which to focus improvement efforts. The experimental facilities formed local change teams and were provided external coaching based on the Network for the Improvement of Addiction Treatment (NIATx) process improvement model. Difference-indifference analyses indicate a significant relative increase in HIV testing in the experimental compared to the control condition. Meta-analyses across the matched pairs indicated a small to medium effect of increased testing overall. The results indicate that the local change team model can achieve significant increases in HIV testing in correctional facilities. Implications for HIV testing policies and challenges for expanding testing are discussed.

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. The HIV Services and Treatment Implementation in Corrections protocol of the NIDA funded Criminal Justice Drug Abuse Treatment Studies cooperative tested the efficacy of an organizational process improvement strategy on improving HIV services in correctional facilities. For this paper, we analyzed efficacy of this strategy on improving inmate awareness and perceptions of HIV services. The study used a multi-site (n=28) clustered randomized trial approach. Facilities randomized to the experimental condition used a coach-driven local change team approach to improve HIV services at their facility. Facilities in the control condition were given a directive to improve HIV services on their own. Surveys about awareness and perceptions of HIV services were administered anonymously to inmates who were incarcerated in study facilities at baseline (n=1253) and follow-up (n=1048). A series of one-way ANOVAs were run to test whether there were differences between inmates in the experimental and control facilities at baseline and follow-up. Differences were observed at baseline, with the experimental group having significantly lower scores than the control group on key variables. But, at post-test, following the intervention, these differences were no longer significant. Taken in context of the findings from the main study, these results suggest that the change team approach to improving HIV services in correctional facilities is efficacious for improving inmates' awareness and perceptions of HIV services.

Efficacy of a process improvement intervention on delivery of HIV services to offenders: a multisite trial.

OBJECTIVES: We tested a modified Network for the Improvement of Addiction Treatment (NIATx) process improvement model to implement improved HIV services (prevention, testing, and linkage to treatment) for offenders under correctional supervision. METHODS: As part of the Criminal Justice Drug Abuse Treatment Studies, Phase 2, the HIV Services and Treatment Implementation in Corrections study conducted 14 cluster-randomized trials in 2011 to 2013 at 9 US sites, where one correctional facility received training in HIV services and coaching in a modified NIATx model and the other received only HIV training. The outcome measure was the odds of successful delivery of an HIV service. RESULTS: The results were significant at the .05 level, and the point estimate for the odds ratio was 2.14. Although overall the results were heterogeneous, the experiments that focused on implementing HIV prevention interventions had a 95% confidence interval that exceeded the no-difference point. CONCLUSIONS: Our results demonstrate that a modified NIATx process improvement model can effectively implement improved rates of delivery of some types of HIV services in correctional environments.

Online illegal drug use information: an exploratory analysis of drug-related website viewing by adolescents.

Given the uncertain effects of antidrug media campaigns, and the ease of finding online illegal drug information, research is needed on the Internet role in disseminating drug information to youths. This exploratory study analyzes National Survey of Parents and Youth (NSPY) data on drug website viewing among 12-18 year olds (N = 7,145). Approximately 10.4% reported drug-related website exposure: 5.4% viewed only websites that communicated how to avoid drugs or bad things about drugs (antidrug websites); 1.7% only viewed websites that communicated how to use drugs and good things about drugs (prodrug websites); and 3.2% viewed both types of websites. The low rates of viewing antidrug websites occurred despite efforts in the National Youth Antidrug Media Campaign (NYAMC) to encourage youths to visit such websites. Prodrug website viewers had used inhalants and been offered marijuana, perceived little risk in trying marijuana, intended to use marijuana, had close friends who used drugs, reported low parental monitoring, and had been exposed to antidrug media messages. Viewing antidrug websites was related to gender, income, likelihood of using marijuana in the next 12 months, having close friends who use drugs and talking to friends about avoiding drugs, parental monitoring, and drug prevention exposure. Prior prevention exposure increased drug website viewing overall, perhaps by increasing general curiosity about drugs. Because adolescents increasingly seek health information online, research is needed on how they use the Internet as a drug information source, the temporal relationships of prevention exposure and drug website viewing, and the effects of viewing prodrug websites on drug risk.

A National Survey of State Legislation defining mental retardation: implications for policy and practice after Atkins.

In Atkins v. Virginia 2002, the U.S. Supreme Court held that the Eighth Amendment prohibits executing offenders who are mentally retarded. Rather than adopting a uniform definition of mental retardation, the court charged each state with defining mental retardation in a manner that enforces the constitutional restriction. An unanswered question is how states define mental retardation after Atkins, which has implications for capital defendants and forensic evaluators who conduct capital mitigation evaluations. This project identified the statutory definitions of mental retardation in each state, and grouped the definitions based on consistency with accepted clinical criteria for mental retardation. Results show that definitions of mental retardation vary considerably by state. The large majority of states, both overall and specifically among death penalty states, use criteria for mental retardation that are not entirely consistent with accepted clinical standards. As such, it is not clear whether the majority of states are effectuating the intent of Atkins. The implications of these findings for both policy and practice are discussed.