Enhanced Support for High Intensity Users of the Criminal Justice System – an evaluation of mental health nurse input into Integrated Offender Management Services in the North East of England

The current UK Government’s focus on the development of services to manage and support offenders with mental health problems has resulted in a number of innovative project developments. This research examines a service development in the North East of England which co-located Mental Health nurses with two Integrated Offender Management teams. While not solving all problems, the benefits of co-location were clear – although such innovations are now at risk from government changes which will make Integrated Offender Management the responsibility of new providers without compelling them to co-operate with health services

Do Family Caps Reduce Out-of-Wedlock Births? Evidence from Arkansas, Georgia, Indiana, New Jersey and Virginia

Using Current Population Survey (CPS) data from 1989 to 1999, we examine the impact of family cap policies, which deny incremental welfare benefits, on out-of-wedlock birth rates. We use the first five states that were granted waivers from the Department of Health and Human Services to implement family caps as "natural experiments." Specifically, we compare trends in out-of-wedlock birth rates in Arkansas, Georgia, Indiana, New Jersey and Virginia to trends in states that did not implement family caps or any other waivers prior to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). We employ several techniques to increase the credibility of results from our "natural experiment," such as the inclusion of multiple comparison groups, controls for differential time trends, and "difference-in-difference-indifferences" estimators. Our regression estimates generally do not provide evidence that family cap policies reduce the incidence of out-of-wedlock births among single, less-educated women with children.Welfare, Family Caps, Fertility

Prison Health Discharge Planning- Evidence of an integrated care pathway or the end of the road?

This article is based on research conducted in several prisons in North East England. It explores the effectiveness of prisons, and the wider criminal justice system, at meeting the healthcare needs of inmates as they leave prison, or transfer between prisons. In doing so, the article details policy context, areas of good practice and issues that still need to be addressed in relation to the creation of an integrated care pathway

The identification of the careers of mentally disordered offenders using cluster analysis in a complex realist framework

Custody diversion teams were introduced in order to divert mentally disordered offenders away from the criminal justice system and custody because of concerns about the growing prevalence of psychiatric disorder in prison populations. This research explores the impact of one such team on the psychiatric and criminal careers of people referred to it. The framework provided by a complex realist approach, along with the technique cluster analysis, were used to identify and map the different institutional careers experienced by people referred to the Cleveland Diversion Team and the different paths their careers took as a consequence of the team's actions. Five different types of career were identified. Careers One and Two describe experiences of criminalisation - violent offenders with no psychiatric history who were referred, assessed and diagnosed but had no health or social care needs identified and were not referred again. Careers Three and Four describe experiences of criminalisation - violent offenders with a psychiatric history half of whom (Career Three) were referred, assessed and diagnosed, had health or social care needs identified and were not referred again; the remainder (Career Four) were not assessed or diagnosed, nor did they have needs identified and consequently all were re-referred repeatedly. Career Five represents neither medicalisation or criminalisation - individuals referred for information and for whom little else is known. The implications of these findings include re-focusing the diversion service on Careers Three and Four. This would avoid stigmatising Careers One and Two and achieve positive outcomes by assessing and meeting the needs of all those in Careers Three and Four. In addition there is the promising application of this methodology elsewhere in other research which involves the analysis of large and complex datasets describing social processes

Using neighborhood-level census data to predict diabetes progression in patients with laboratory-defined prediabetes

Context Research on predictors of clinical outcomes usually focuses on the impact of individual patient factors, despite known relationships between neighborhood environment and health. Objective To determine whether US census information on where a patient resides is associated with diabetes development among patients with prediabetes. Design Retrospective cohort study of all 157,752 patients aged 18 years or older from Kaiser Permanente Northern California with laboratory-defined prediabetes (fasting plasma glucose, 100 mg/dL-125 mg/dL, and/or glycated hemoglobin, 5.7%-6.4%). We assessed whether census data on education, income, and percentage of households receiving benefits through the US Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) was associated with diabetes development using logistic regression controlling for age, sex, race/ethnicity, blood glucose levels, and body mass index. Main Outcome Measure: Progression to diabetes within 36 months. Results Patients were more likely to progress to diabetes if they lived in an area where less than 16% of adults had obtained a bachelor’s degree or higher (odds ratio [OR] =1.22, 95% confidence interval [CI] = 1.09-1.36), where median annual income was below $79,999 (OR = 1.16 95% CI = 1.03-1.31), or where SNAP benefits were received by 10% or more of households (OR = 1.24, 95% CI = 1.1-1.4). Conclusion Area-level socioeconomic and food assistance data predict the development of diabetes, even after adjusting for traditional individual demographic and clinical factors. Clinical interventions should take these factors into account, and health care systems should consider addressing social needs and community resources as a path to improving health outcomes

The Development of a Prison Mental Health Unit in England: Understanding Realist Context(s).

A pragmatic solution for the provision of care for prisoners with serious mental illness, who are often subject to delays in hospital transfer, is the creation of specialist prison units. This paper analyses the development of a prison unit in England for prisoners with ‘serious mental illness’. The unit was developed within over-lapping health and justice contexts, including expectations, pressures and priorities, which impacted on the outcomes expected and achieved. The methodology included attendance at Steering group meetings, analysis of a minimum dataset, and interviews with key stakeholders. A number of key sites of contestation are analyzed including: admission criteria; aims; activities; staffing; the physical environment; and discharge

The sources of adversity in the delivery of mental healthcare in prisons

In 2006, the National Health Service commenced with assuming responsibility for the delivery and commissioning of mental healthcare services in prisons within the UK. Previous research has indicated that some prison environments may present challenges to the delivery of mental healthcare for prison populations. The present study aimed to explore the experiences of staff working in NHS offender health teams to identify the sources of adversity that frontline staff may encounter when providing mental healthcare in prison settings. The present study also aimed to identify working conditions that may be conducive in facilitating the delivery of mental healthcare in prison settings. Mental healthcare professionals (n = 10) who worked in NHS offender health teams took part in 1:1 semi-structured interviews that were audio recorded and transcribed verbatim. The thematic analysis of the dataset indicated three themes that presented sources of adversity for NHS offender health teams in their delivery of mental health care in prisons; which were 1) location of mental healthcare delivery 2) communication links with stakeholders and 3) prison policies, procedures and legislation. The results of this study have illustrated some of the work-related factors that require attention in order to further support frontline staff in their delivery of mental healthcare in prison settings