The application of implementation science methods in correctional health intervention research: a systematic review

Enhancing HIV Prevention Efforts in the Criminal Legal System: A Comprehensive Review and Recommendations

BACKGROUND

Despite encouraging declines in the overall rate of new transmission globally, HIV prevention efforts targeting individuals in the criminal legal system continue to significantly lag behind rates identified in the general population. Prevention efforts targeting this group worldwide remain geographically uneven and differ across the continuum of legal system involvement (diversion, arrests, community supervision, and post-release), which is attributed to social, structural, and systemic barriers. These gaps are noted to disproportionately impact minoritized and other transmission-burdened populations within the criminal legal system (e.g., men who have sex with men).

OBJECTIVE

Given these challenges, this literature review examines HIV prevention efforts targeting individuals in the criminal legal system across the globe.

METHODS

This review identifies current reach and gaps in prevention care and proposes strategies for improvement.

RESULTS

Recommendations include updating and utilizing long-term platforms for sustained HIV prevention interventions, developing a global compendium for regions outside the U.S., enhancing targeted interventions in high-risk areas, and integrating HIV prevention with other health services while addressing stigma.

CONCLUSIONS

These actions are critical for ensuring that interventions remain up-to-date, sustainable, and culturally responsive, effectively addressing the unique needs of diverse populations and criminal legal system contexts. These measures are also vital for meeting the U.N. 95-95-95 targets for HIV testing, treatment, and viral suppression, ultimately contributing to the goal of ending the HIV epidemic among this high-need population.

"Looking back to look forward": evaluation of a leadership program for prison staff designed to promote public health-focused culture change in US prisons

PURPOSE

Prisons are associated with poor health outcomes for incarcerated people and correctional staff. Efforts to remedy harmful prison conditions typically focus on litigation, legislation and administrative policy changes; however, implementing these top-down mandates is often impeded by cultural barriers among prison staff. The purpose of this study was to evaluate a novel intervention grounded in public health and international correctional principles, to educate and motivate frontline prison staff to lead culture change initiatives in US prisons.

DESIGN/METHODOLOGY/APPROACH

Guided by an implementation science framework, researchers administered surveys and conducted semi-structured interviews with three cohorts of participants in the Amend Ambassadors Program. This study included a total of 37 participants: 28 US prison staff from four US states (Oregon, California, North Dakota and Washington) and 9 prison staff from Norway. The objectives were to assess the implementation of the program and its impacts based on the experiences of those who participated.

FINDINGS

Results suggest that the Ambassadors program succeeded in its educational objectives, and provided participants with knowledge, skills and motivation to lead culture change projects in the prison systems where they work. Participants responded favorably to the pedagogical components of the program, and most reported improvements in their perceived levels of job satisfaction, overall well-being and inspiration to advance culture change efforts, as a result of their participation in the program.

ORIGINALITY/VALUE

The Amend Ambassadors program is a novel approach to educating and inspiring correctional professionals to mobilize "ground up" culture change initiatives focused on improving human dignity and health promotion. This formative evaluation provides new insights into the potential for interventions that combine international immersion, health promotion and experiential learning components for fostering leadership and reducing cultural resistance to prison reform among prison workforces.

Implementation Science Approaches to Addressing the Social and Structural Determinants of Health of Criminal-Legal Involved People Living With HIV to Improve HIV Care Outcomes

BACKGROUND

People living with HIV in the United States are overrepresented in the criminal-legal system and experience unique barriers to engagement in HIV care postincarceration. Individuals who are criminal-legal involved (CLI) experience worse HIV care outcomes compared to the general population. Interventions aiming to improve engagement and retention in HIV care for CLI populations are urgently needed. This study aims to highlight an array of NIH-funded research projects across the United States leveraging implementation science to investigate and design interventions aimed at addressing social determinants of health and improving HIV care outcomes among CLI populations in the United States.

SETTING

United States.

METHODS

In September 2023, the National Institutes of Health funded 47 new implementation research projects as part of the Ending the HIV Epidemic initiative, including 10 projects focused on addressing HIV among CLI populations. This paper highlights several projects that are addressing the social determinants of health affecting CLI populations living with HIV in the United States.

PROJECT OVERVIEW

The funded projects use innovative, community-engaged approaches to investigate and design interventions to address social determinants of health among CLI populations living with HIV including health care access, legal needs, social support, and holistic needs.

CONCLUSIONS

We believe these projects will substantially contribute to the evidence base to aid the development of guidelines and the implementation of programs that can be adopted and adapted by a wide range of settings working toward improving the health and wellness of CLI people living with HIV.

Leveraging the science of implementation: the case for specialized mental health community supervision

People with mental illnesses are overrepresented in criminal legal systems internationally, making addressing mental health among this population a global public health concern. Across the world, community supervision agencies (i.e., probation and parole) have implemented a variety of innovative and evidence-informed approaches to improve outcomes for people with mental illness. However, the demonstrated success of these approaches in one region or country does not guarantee effectiveness in another due to significant variations in the implementation context, including differences in governance and administration, society and culture, and resource constraints. Applying implementation science methods throughout the phases of intervention (design and development, implementation, and evaluation) provides tools that can help translate innovations within and across different agencies, countries, and contexts. To highlight how implementation science methods can be used to adapt and implement health interventions within criminal legal system settings, this perspective uses the example of specialized mental health community supervision in the USA. Drawing on general implementation science principles and the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we articulate key questions and steps agencies can take to translate health interventions from theory into practice.

The wide-angle lens of implementation science to improve health outcomes in criminal legal settings

BACKGROUND

Implementation science (IS) is an emerging discipline that offers frameworks, theories, measures, and interventions to understand both the effective organizational change processes and the contextual factors that affect how well an innovation operates in real-world settings.

RESULTS

In this article, we present an overview of the basic concepts and methods of IS. We then present six studies where IS was used as a means to understand implementation of a new innovations designed to improve the health and well-being of individuals under criminal legal system supervision.

CONCLUSION

We discuss how IS has developed new knowledge on how to implement efficacious innovations and suggesting future research needed to further our understanding of implementation and sustainability of innovations in the legal context.

Medication for opioid use disorder service delivery in carceral facilities: update and summary report

The opioid overdose crisis intersects critically with the criminal legal system where individuals with opioid use disorder (are significantly overrepresented. Subsequently, incarceration increases the risk of opioid overdose due to reduced tolerance, interrupted social supports, and limited access to treatment. Medications for opioid use disorder (MOUD), such as methadone, buprenorphine, and naltrexone, have been shown to reduce opioid-related mortality and improve outcomes for those in carceral settings. Despite this, access to MOUD in jails and prisons remains limited due to stigma, concerns about medication diversion, and logistical challenges. This paper reviews the current state of knowledge on MOUD in carceral settings, summarizing the prevalence of treatment programs, the role of novel formulations like injectable buprenorphine, and barriers to implementation. It also explores the continuum of care, emphasizing the importance of initiating MOUD during incarceration and ensuring continuation upon release to prevent treatment gaps. Recent policy changes, such as Sect. 1115 Medicaid waivers, offer promising avenues for expanding access, but retention in treatment and post-release outcomes remain significant challenges. The paper provides a comprehensive overview of existing literature and updates on MOUD service delivery, including the impact of recent policy shifts and research on outcomes such as recidivism and health improvement. It concludes by identifying key areas for future research, including strategies to improve treatment retention, address systemic barriers through criminal justice reform, and enhance care coordination during the transition from incarceration to the community.

Addressing Barriers to Implementing and Scaling PrEP in Carceral Settings: Applying Insights From Implementation Science

INTRODUCTION

Within the United States, individuals experiencing incarceration are at higher risk for HIV acquisition than the general population, yet may face additional difficulty engaging in HIV prevention clinical services. HIV preexposure prophylaxis (PrEP) is an effective approach to preventing HIV transmission, and the Centers for Disease Control recommends that PrEP be offered in carceral settings, particularly during the vulnerable community reentry period. However, there have been few efforts to scale PrEP in this setting.

METHODS

Based on our experience implementing PrEP in Rhode Island's state carceral system, we have identified potential approaches to overcoming barriers to PrEP use in this unique practice environment by using the implementation research logic model. We then evaluated specific implementation determinants and barriers as well as strategies used to overcome those barriers to effectively scale PrEP in this setting.

RESULTS

We developed a "toolkit," or 14-step guide, for others in the field to use for implementing PrEP in carceral settings, including the development and use of clinical protocols and community linkage strategies.

DISCUSSION

Our experiences with barriers in the carceral setting, identifying and leveraging implementation strategies, allowed us to develop a "toolkit" to guide other PrEP implementation projects in carceral settings. We encourage others to scale-out our work to other carceral settings to better reach and engage a group of individuals both at elevated risk for HIV and currently underserved by HIV prevention strategies, including PrEP.

Integrating Implementation Science in Interpersonal Violence Research and Practice: A Systematic Review of Barriers and Facilitators of Implementation

Despite the prevalence and harmful consequences of interpersonal violence and the growth in intervention research, applying research evidence and strategies into practice remains limited. This systematic review addresses this gap by using the Consolidated Framework of Implementation Research (CFIR) to characterize barriers and facilitators in efforts to prevent and address interpersonal violence. A systematic search of peer-reviewed literature was conducted using the following databases: PubMed, Embase, CINAHL, Cochrane, Web of Science, Scopus, and APA PsycInfo. The searches resulted in 1,319 articles for initial screening, with 31 studies included in the final synthesis. The selected studies were original research highlighting barriers and facilitators of implementing interpersonal violence interventions for adolescents and adults across various US settings, employing quantitative, qualitative, or mixed methods approaches. Excluded studies included protocols, reviews, and research that did not identify barriers or facilitators of implementing violence prevention or intervention programs. Published from 2007 to 2023, the selected studies spanned healthcare, school, community, correctional, and military settings. Using the CFIR, the review identified multilevel barriers (e.g., lack of cultural relevance, leadership commitment) and facilitators (e.g., intervention adaptability, stakeholder engagement) across five domains: outer setting (external factors), inner setting (organizational characteristics) implementation process, individual characteristics, and intervention characteristics. These findings underscore the importance of adaptable, culturally relevant strategies and comprehensive stakeholder involvement for effective implementation. The review emphasizes the need for enhanced pre-implementation planning, capacity building, and organizational support to address identified barriers. Furthermore, it highlights the necessity for further research in under-researched settings, employing evidence-based implementation strategies.

Implementing Reform: Approaches to Alter the Use of Local Jail for People with Behavioral Health Conditions

To reduce the overrepresentation of people with behavioral health conditions in jails, jurisdictions have implemented evidence-based programs/policies (EBPPs) and treatments (EBTs). Using survey data from 519 U.S. counties, the present study classifies and evaluates the impact of strategies used to implement EBPPs and EBTs. Exploratory factor analysis identified four implementation approaches (i.e., clusters of strategies) which counties utilize to different extents depending on their population size: Relationship-Building among agencies (α = .911), infrastructural Capacity-Building (.788), developing Quality Programming (.880), and establishing Shared Definitions of key terms (.913). Relationship-Building and Shared Definitions were significant predictors of increased county-level availability of EBPPs and EBTs. These findings indicate that approaches focusing on interagency collaboration appear especially impactful. However, strategies that require more resources (viz. Capacity-Building) are underutilized. For smaller and/or rural counties with limited resources, an initial emphasis on interagency collaboration approaches can yield positive outcomes, as these require less initial investment and appear especially versatile.

Implementation Science and Pediatric Diabetes: A Scoping Review of the State of the Literature and Recommendations for Future Research

PURPOSE OF REVIEW

This scoping review aimed to identify implementation science (IS) research in pediatric diabetes, report integration of IS theory and terminology, and offer guidance for future research.

RECENT FINDINGS

Of 23 papers identified, 19 were published since 2017 and 21 focused on type 1 diabetes. Most involved medical evidence-based practices (EBPs; n = 15), whereas fewer focused on psychosocial (n = 7) and diabetes education (n = 2). The majority either identified barriers and facilitators of implementing an EBP (n = 11) or were implementation trials (n = 11). Fewer studies documented gaps in EBP implementation in standard care (n = 7) or development of implementation strategies (n = 1). Five papers employed IS theories and two aimed to improve equity. There is a paucity of IS research in pediatric diabetes care literature. Few papers employed IS theory, used consistent IS terminology, or described IS strategies or outcomes. Guidance for future research to improve IS research in pediatric diabetes is offered.

"It's easier to take a pill than fix a problem:" qualitative analysis of barriers and facilitators to antimicrobial stewardship program implementation in carceral settings

BACKGROUND

Widespread antibiotic prescribing contributes to globally emerging antimicrobial resistance (AMR). Despite stewardship recommendations by the Infectious Diseases Society of America, there is a lack of literature identifying barriers and facilitators to antimicrobial stewardship programs (ASPs) in United States (U.S.) carceral settings.

METHODS

Guided by the Theoretic Domains Framework, we performed in-depth interviews with 68 key stakeholders in Massachusetts carceral settings to contextualize barriers and facilitators to ASP implementation. We recruited 32 people incarcerated in Massachusetts jails and 36 carceral clinicians, correctional officers/administrators in Massachusetts and other U.S. states, and Massachusetts community clinicians for interviews.

RESULTS

From the completed semi-structured in-depth interviews, we identified seven salient themes-four barriers and three facilitators-both specific to and across stakeholder groups. Barriers included the following: (1) jail being viewed as a "dirty place" that increases the risk of infections; (2) variable awareness and knowledge of AMR and ASPs; (3) clinicians' opposition to change and oversight of their antibiotic prescribing; (4) competing priorities taking precedence over ASP implementation. Facilitators included (5) interest in changing the narrative about carceral healthcare through ASP implementation; (6) opportunities for education about ASP and AMR; and (7) the development of systems, policies, and regulations to improve antibiotic prescribing.

CONCLUSIONS

To our knowledge, this is the first qualitative study to leverage broad criminal-legal stakeholder groups to inform the next steps in developing and implementing ASPs in carceral settings in the U.S.

Implementing Interventions for Women and Youth with Traumatic Brain Injury at Transition from Custodial Settings: A Call to Action

Traumatic brain injury (TBI) is a serious public health concern and overrepresented among justice-involved populations. An emerging area of research focuses on the complex, interrelated and unmet health and social needs of justice-involved women and youth with TBI. Evidence of these needs continues to grow, yet the health and justice systems continue to underperform in supporting the health and social care of justice-involved women and youth. This commentary is a call to action to begin to redress these gaps. We first provide an overview of the needs of women and youth with TBI that affect their transition from custody to community, including those related to victimization, trauma, mental health, substance use, and homelessness. We then highlight the current gaps in knowledge and practice with respect to interventions for women and youth with TBI at transition from custody. The available evidence for the impact of interventions on people with head injury who are justice-involved is sparse, especially studies of interventions focused on women and youth. We conclude with a call for implementation science studies to support translation from research to practice, emphasizing that researchers, practitioners, policy makers, and women and youth at transition should collaborate to develop, implement, and evaluate accommodations and interventions for TBI. To have meaningful, positive impacts on the systems that serve these women and youth, interdisciplinary service delivery approaches should aim to prevent, raise awareness, identify, and provide timely support and services for the varied needs of women and youth with TBI in transition.

Implementing a Treatment for People with Serious Mental Illness in Jail: A Mixed-Methods Study of Stakeholder Perspectives on Feasibility and Acceptability

People with mental illness are over-represented in the U.S. criminal legal system. Jail presents an optimal opportunity to provide needed mental health care as the entry point to corrections. However, there is a lack of programming available in jails, which may be partly due to limited understanding of how to successfully implement interventions in this complex setting. We implemented a nine-session psychotherapeutic intervention for people with serious mental illness in a county jail. As part of a larger implementation-effectiveness hybrid study, we gathered mixed-methods data from stakeholders (treatment recipients and jail administrators) on the feasibility and acceptability of the intervention's implementation. In focus group discussions and qualitative interviews, treatment recipients (n = 29) provided qualitative and quantitative data on their perceptions of the implementation's feasibility and acceptability. Jail administrators (n = 6) completed two quantitative self-report measures on their perceptions of the treatment's feasibility and acceptability. Qualitative analyses were conducted by two coders using inductive thematic template analysis; seven global themes relating to treatment recipients' perceptions of the assets and hindrances to feasibility and acceptability were developed and are presented with supporting quotations. Quantitatively, all treatment recipients endorsed the intervention's feasibility (100%), and nearly all (97%) endorsed its acceptability. On both self-report measures, jail administrators' mean scores fell above a-priori thresholds indicating feasibility and acceptability. We found qualitative and quantitative support for the use of this intervention in jail from both sets of stakeholders. These results have implications for clinical service and policy in jail, where service providers struggle to meet the considerable demand for mental health services.

Locked in and left out: the "prison penalty" for implementation of evidence-based interventions

BACKGROUND

While the broader medical community grapples with the widely accepted notion that it takes an average of 17 years for research evidence to be incorporated into clinical practice, the implementation of evidence-based interventions in carceral settings (i.e., jails and prisons) faces longer delays, exacerbating health disparities.

MAIN BODY

The "prison implementation penalty" describes the significant delay in and limited adoption of evidence-based healthcare practices in carceral settings. We explore the complex challenges of implementing evidence-based interventions in jails and prisons, environments where healthcare often plays a secondary role under security and discipline. We use specific frameworks to highlight the unique barriers within these settings and propose potential implementation strategies. These challenges have broad implications for health equity due to the disproportionate impact on the marginalized groups affected by mass incarceration. Implementation science has potential to mitigate these disparities.

CONCLUSION

Bridging the gap between healthcare evidence and practice in carceral settings offers a public health opportunity. Implementation science offers a unique role in improving healthcare standards and reducing health inequities in this environment.