Advancing the science and practice of health care for justice-involved individuals

Our nation’s correctional population is about 6.6 million including those individuals supervised by probation and/or parole agencies, according to the latest figures from the U.S. Bureau of Justice Statistics. Over two million of those are incarcerated and in the custody of a state or federal prison or local jail. It has been reported time and time again that inmates have greater health needs than those living in the community, including higher rates of Hepatitis C, HIV/AIDS, mental health issues and substance use disorder. There is still much we can improve upon in the way we deliver care to individuals in prisons and jails across the United States

Strategies for Reducing Adverse Outcomes for Criminal Justice-Involved Populations

In the United States, we spend $81 billion taxpayer dollars annually on the costs of incarceration according to the Bureau of Justice Statistics, but including other costs may increase that estimate to$181 billion. Data from Worcester suggest that the cost of incarcerating individuals in the Piedmont neighborhood of Worcester eclipse the entire annual budget of the Division of Public Health in Worcester. With a hard line on petty crime, lack of substance use disorder treatment in jail and prison, concentrated policing and racial profiling in low income communities of color and poor reentry support services, mass incarceration is destined to continue. The opioid crisis in Massachusetts has affirmed that individuals with a history of incarceration and opioid use disorder are at greatest risk for nonfatal and fatal overdose. Furthermore, homelessness and serious mental illness increase that risk dramatically. In turn, the Governor and Secretary of Health and Human Services in concert with the Massachusetts Medicaid Program, the Department of Public Health and the Trial courts have undertaken a multi-pronged strategy to mitigate those risks. This panel will present three interventions to improve those outcomes. Three panelists will describe and present findings on three studies completed and in process to reduce the health risks for justice-involved persons in Massachusetts. Dr. Ferguson will describe an implementation science study of four correctional systems which embarked on medication assisted therapies for opioid use disorder which has helped to inform current mixed methods research to study a pilot of medication assisted treatment in seven Massachusetts jails; Dr. Pivovarova will describe her study of health status for individuals participating in Drug Court, a diversionary program that mandates substance use disorder treatment in the community for individuals arrested for drug related offenses; and Ms. Dupuis will describe the MassHealth funded Behavioral Health Justice Involved project to provide returning citizens with navigators to assist them in linking to community-based treatment and to address social determinants of health such as housing and employment. During the presentations, attendees will be asked to formulate questions or reflections for discussion. These will be collected and prioritized by the moderator of the session for further discussion

Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails

BACKGROUND: Opioid use disorder (OUD) is among the most prevalent medical condition experienced by incarcerated persons, yet medication assisted therapy (MAT) is uncommon. Four jail and prison systems partnered with researchers to document their adoption of MAT for incarcerated individuals with opioid use disorders (OUD) using their established treatment protocols. Employing the EPIS (Exploration, Planning, Implementation, and Sustainment) framework, programs report on systematic efforts to expand screening, treatment and provide linkage to community-based care upon release. RESULTS: All four systems were engaged with implementation of MAT at the outset of the study. Thus, findings focus more on uptake and penetration as part of implementation and sustainment of medication treatment. The prevalence of OUD during any given month ranged from 28 to 65% of the population in the participating facilities. All programs developed consistent approaches to screen individuals at intake and provided care coordination with community treatment providers at the time of release. The proportion of individuals with OUD who received MAT ranged considerably from 9 to 61%. Despite efforts at all four sites to increase utilization of MAT, only one site achieved sustained growth in the proportion of individuals treated over the course of the project. Government leadership, dedicated funding and collaboration with community treatment providers were deemed essential to adoption of MAT during implementation phases. Facilitators for MAT included increases in staffing and staff training; group education on medication assisted therapies; use of data to drive change processes; coordination with other elements of the criminal justice system to expand care; and ongoing contact with individuals post-release to encourage continued treatment. Barriers included lack of funding and space and institutional design; challenges in changing the cultural perception of all approved treatments; excluding or discontinuing treatment based on patient factors, movement or transfer of individuals; and inability to sustain care coordination at the time of release. CONCLUSIONS: Adoption of evidence-based medication assisted therapies for OUD in prisons and jails can be accomplished but requires persistent effort to identify and overcome challenges and dedicated funding to sustain programs