DOES THE TIMING OF INCARCERATION IMPACT THE TIMING AND DURATION OF HOMELESSNESS? EVIDENCE FROM "THE TRANSITIONS TO HOUSING" STUDY

Integrating People With Lived Experience of Carceral System Involvement Into Research: Lessons Learned From Ending the HIV Epidemic Research Teams

BACKGROUND

The National HIV/AIDS Strategy for the United States 2022-2025 emphasized carceral settings for the first time in the national strategy. Centering impacted people can take many forms and is critical to improving the HIV care continuum among people with carceral system involvement (CSI) to meet national Ending the HIV Epidemic goals.

METHODS

We provide a narrative synthesis of the barriers and facilitators of including people with CSI in different aspects of the research process across 5 Ending the HIV Epidemic studies. Data were collected from each team using a data collection form with open-ended questions. A qualitative thematic analysis identified strategies, barriers, and facilitators across studies.

FINDINGS

Major barriers to including people with CSI in research included institutional policies surrounding participant compensation and hiring practices, as well as a misalignment between the study objectives and the perceived needs of participants. Successful strategies for including people with CSI as part of the research team included providing training, support, and space for emotional processing and self-care to aid in managing the vicarious trauma and boundary setting that are unavoidable parts of this work. Successful strategies for including people with CSI as research participants include flexible research protocols and providing material support for participants in addition to cash payments for participation.

CONCLUSIONS

It is imperative to create sustainable and equitable, community-engaged research practices that continue to center CSI populations during their involvement in all aspects of HIV-related research studies.

Usability of a cross-system housing stability program for juvenile courts: A multimethod study of probation counselor perspectives

Background

Youth in contact with the juvenile legal system experience disproportionate rates of homelessness. While system contact is a critical intervening point, juvenile courts do not typically offer housing services. One solution is to refer youth to evidence-based, community-based services to meet housing-related needs, but a myriad of individual and organizational factors often impede court staff from making such referrals. Housing Stability for Youth in Courts (HSYNC) is a novel, cross-system service linkage model for court-involved youth facing housing instability. HSYNC was developed using codesign as a strategy to improve usability and incorporated evidence on juvenile court linkage strategies effective at increasing service referrals and improving outcomes.

Method

The current study utilized a multimethod approach to evaluate the usability of HSYNC from the perspective of juvenile probation counselors (JPCs) as one group of end-users. As part of the pilot implementation study, survey (N = 15) and semi-structured interview (N = 20) data were obtained from JPCs from four juvenile courts in one northwestern state.

Results

Survey results indicated good usability for HSYNC (mean implementation strategy usability scale score of 80). Themes from the interviews complemented survey findings, pointing to HSYNC as a value-added program that integrated well with existing probation practices. The housing navigator's approach was highlighted as a strong facilitator of program usability. Themes also provided greater insight into implementation barriers (i.e., individual and contextual factors) and areas for improvement (e.g., eligibility screening process).

Conclusions

Drivers of program usability and implications for program improvement to address identified implementation challenges to ensure the HSYNC model is effective and sustainable long-term are discussed.

The Role of Incarceration as a Risk Factor for Cognitive Impairment

OBJECTIVES

The objective of this study was to understand disparities in cognitive impairment between middle-aged formerly incarcerated (FI) and nonincarcerated individuals.

METHODS

The 1979 National Longitudinal Survey of Youth is a nationally representative longitudinal data set containing information on incarceration, cognitive functioning, and other health conditions. Using a modified version of the Telephone Interview for Cognitive Status (TICS-m), adapted from the Health and Retirement Study, we analyzed the association between incarceration and cognitive impairment, cognitive impairment-not dementia and dementia. Multivariable regression models were estimated, including prior incarceration status and covariates associated with incarceration and cognitive functioning.

RESULTS

FI individuals had lower unadjusted scores on TICS-m (-2.5, p < .001) and had significantly greater unadjusted odds ratios (OR) for scoring in the cognitive impairment (OR = 2.4, p < .001) and dementia (OR = 2.7, p < .001) range. Differences were largely explained by a combination of risk factors associated with incarceration and cognition. Education and premorbid cognition (measured by Armed Forces Qualification Test) separately and completely explained differences in the odds of dementia. Regardless of incarceration status, Blacks and Hispanics had significantly greater odds of cognitive impairment and dementia relative to Whites, holding other factors constant.

DISCUSSION

The association between prior incarceration and cognitive impairment in middle age was largely explained by differences in educational attainment and premorbid cognitive functioning, supporting the cognitive reserve hypothesis. Greater prevalence of cognitive impairment and dementia among the FI could create challenges and should be considered in reentry planning. Structural and institutional factors should be considered when addressing health disparities in Alzheimer's Disease and Related Dementias.

The impact of a Housing First intervention and health-related risk factors on incarceration among people with experiences of homelessness and mental illness in Canada

OBJECTIVE

To examine the effect of a Housing First (HF) intervention and health-related risk factors on incarceration among adults with experiences of homelessness and mental illness.

METHODS

Participants (N = 508) were recruited at the Toronto site of the At Home/Chez Soi study. The outcome was incarceration in Ontario from 2009 to 2014. Exposures were intervention group (HF vs. treatment as usual), Axis I mental health diagnoses, emergency department (ED) visit, and history of traumatic brain injury (TBI). Logistic regression was used to examine the association between exposures and incarceration.

RESULTS

Of 508 participants, 220 (43.3%) were incarcerated at least once during the study period. Among those incarcerated, 81.9% were male, 52.7% had been diagnosed with alcohol dependence/abuse, 60.9% had been diagnosed with substance dependence/abuse, 65.1% reported having visited an ED within the last 6 months, and 66.4% had a history of TBI. After adjusting for demographic covariates, substance dependence/abuse (aOR: 2.06; 95% CI: 1.40, 3.03), alcohol dependence/abuse (aOR: 1.52, 95% CI: 1.04, 2.22), ED visit (aOR: 1.54; 95% CI: 1.02, 2.32), and history of TBI (aOR: 2.60; 95% CI: 1.75, 3.85) were associated with incarceration. We found no significant effect of the HF intervention on incarceration outcome (aOR: 1.08; 95% CI: 0.76, 1.55).

CONCLUSIONS

Among adults with experiences of homelessness and severe mental illness, those with substance and alcohol dependence/abuse disorders, history of TBI, and recent ED visits were at increased odds of incarceration. Strategies are needed to prevent and reduce incarceration for this population, including treatment of mental illness in the community.