Pregnancy and substance use disorders (SUD) for incarcerated individuals often overlap, but their management varies greatly between jails. A better understanding of pregnancy management across jails is needed to better guide policy and practice recommendations. To examine the current state of pregnancy management across North Carolina jails, including current practices, challenges, and gaps in pregnancy management in jails. This is a qualitative analysis within a mixed-methods study assessing the scope of perinatal incarceration and the capacity of North Carolina jails to manage perinatal SUD. We conducted in-depth interviews with North Carolina jail staff using a semi-structured interview guide between October 2022 and September 2023. We used the ideal-type analysis approach to systematically compare pregnancy management and SUD management practices across facilities. We completed 26 interviews with jail staff. Pregnancy management approaches were unevenly distributed across three ideal types: (1) exclusive use of internal prenatal care resources (n = 2), (2) exclusive use of external prenatal care resources (n = 16), and (3) hybrid use of both internal and external prenatal care resources (n = 8). Within ideal types, SUD management was highly variable. The heavy reliance on external resources for prenatal and SUD care highlights the chronic underfunding and staffing challenges faced by these facilities. There is an urgent need for standardized policies governing prenatal care in jail facilities to help reduce disparities in care quality and ensure that all pregnant individuals receive adequate support, regardless of the jail's resources. Alternatives to incarceration during pregnancy should be prioritized. Pregnancy management for incarcerated individuals with substance use disorder in North Carolina jailsWhy was the study done? There is an increasing number of pregnant individuals incarcerated in the U.S., and pregnant people who experience incarceration face worse maternal and infant health outcomes. However, management of pregnancy and substance use disorder varies greatly across jails. The research team aimed to fill in the gaps in knowledge surrounding current practices, challenges, and gaps in pregnancy management in North Carolina jails, in order to better guide policies and practices. What did the researchers do? The research team conducted 26 qualitative interviews with North Carolina jail staff between October 2022 and September 2023. The researchers analyzed the transcripts using an ideal-type analysis approach that identified three topics: pregnancy management, SUD management, and policy changes and implementation climate. This analysis focuses on the pregnancy management typology. What did the researchers find? Jails in the sample had three approaches to pregnancy management: (1) exclusive use of internal prenatal care resources, (2) exclusive use of external prenatal care resources, and (3) hybrid use of both internal and external prenatal care resources. The most common approach was exclusive use of external resources, used by 16 jails. What do the findings mean? The findings reveal no standardized prenatal care management across jails and significant variation in the robustness of pregnancy management protocols. The overwhelming reliance on external resources for pregnancy management underscores the resource constraints that many jails face, including insufficient funding, staff shortages, and limited infrastructure to support in-house pregnancy care. The researchers recommend prioritizing alternatives to incarceration during pregnancy to better support both pregnant individuals and under-resourced jails.
There is a significant knowledge gap regarding medication for opioid use disorder (MOUD) and hepatitis C virus (HCV) service provision in U.S. jails. To address this gap, characterized screening, treatment, and discharge planning capacity for OUD and HCV in New York State (NYS) jails outside of New York City. Cross-sectional study. Between August and September 2022, 46 of 58 (80%) NYS jails completed a NYS Department of Health survey to determine jails' capacities to implement MOUD and capacity to screen, test and treat HCV. Surveys were completed prior to the October 2022 statewide mandate deadline to provide MOUD in jails. Most (90%) NYS jails reported offering MOUD care continuation for individuals entering their facilities and 88% offered MOUD initiation. Naltrexone was most frequently used for initiation (67%) and buprenorphine for continuation (79%). Self-reported staff capacity to provide HCV screening was high (89%), yet 41% offered routine opt-in HCV screening and only 15% offered opt-out. Most facilities (84%) continued HCV treatment, though only 29% initiated treatment for newly diagnosed individuals. Although half of facilities (51%) had referral agreements with a community provider to facilitate post-release linkage, limited rapid test kits and education resources were barriers to jail-based HCV services. MOUD availability in NYS jails is promising, but limited HCV service availability suggests support is needed to overcome financial and structural barriers. Strategies such as universal opt-out testing at intake, and task shifting jail-based discharge planning from staff to patient/peer navigators could significantly improve care in jail settings and during reentry.
Individuals with opioid use disorder (OUD) may experience fewer barriers to treatment following incarceration if offered in-jail medications for OUD (MOUD). We aimed to identify care trajectories of community OUD treatment after incarceration and examine the association between receiving in-jail MOUD and experiencing specific community treatment trajectories. This retrospective cohort study using matched New York City (NYC) health care administrative data included adults with OUD incarcerated on or after May 2011 and discharged during 2014-2017. We defined states of community OUD treatment at the weekly level over one year following index jail discharge and performed state sequence analysis (SSA) to identify trajectories of treatment after jail and assessed the influence of receiving in-jail MOUD on treatment trajectories. Of 14,923 eligible individuals, 26.2% received in-jail MOUD. SSA identified eight clusters of community care trajectories: continuous methadone treatment (9.7%), methadone treatment discontinuation (3.7%), methadone treatment and reincarceration (6.7%), methadone treatment initiation (4.8%), continuous reincarceration (3.5%), short reincarceration with little community treatment (20.3%), long reincarceration with little community treatment (7.0%), and no community OUD treatment or reincarceration (44.5%). Receiving in-jail MOUD was associated with belonging to the continuous methadone treatment cluster compared to the no community OUD treatment or reincarceration cluster (adjusted OR: 12.5, 95% CI: 9.9-15.7). We identified eight unique patterns of community OUD treatment after jail release. Receipt of in-jail MOUD was associated with belonging to the continuous methadone treatment cluster. These findings suggest that provision of in-jail MOUD could improve methadone uptake in the community.
Medication for opioid use disorder (MOUD) treatment is increasingly available within jails, but little is known about patient experiences regarding treatment continuity post-release. Between 2021 and 2022, we interviewed 38 recently-released people who received MOUD in Massachusetts county jails. We asked participants about their experiences with reentry and MOUD continuity post-release. Thematic analyses were framed by the social-ecological model. At the individual-interpersonal level, participants reported the importance of self-advocacy during incarceration to plan for post-release MOUD treatment continuity. They cited increasing awareness of diminished opioid tolerance as a risk factor for post-release overdose. Participants reported hopelessness about recovery when returning to communities saturated with substance use-related triggers. Participants recognized social support systems as crucial. At the organizational level, participants reported variation by facility in reentry assistance. Detail-oriented reentry teams, active outreach, follow through, clear communication, caring attitudes, and early initiation of reentry planning were key to filling gaps in treatment post-release. Community-level themes emphasized the importance of communication between jail staff and community providers to schedule appointments and provide transportation. At the policy level, advanced reentry planning is needed to avoid treatment lapses, including assistance with health insurance reactivation and bridge prescriptions during the transition from jail-based to community-based MOUD. Participants recognized the high risk of MOUD treatment lapses during transitions from jail to community reentry, and valued MOUD continuity services initiated during incarceration and continued post-release. Variation in patient-reported quality of reentry planning services underscored the need for more standardized investment in re-entry and treatment continuity services.
People incarcerated experience significant health inequities compared to the non-incarcerated population, including higher rates of many diet-related diseases. Despite widespread acceptance of the association between diet and health, research documenting the dietary intake and nutritional status of individuals incarcerated in jail is limited. Food intake is notoriously difficult to measure, and current measurement tools are not designed for the jail setting. This study aimed to assess the acceptability and feasibility of a comprehensive tool to assess food intake during incarceration. The cycle menu and commissary list from a rural county jail in the Southwest United States were used to design a dietary assessment questionnaire tailored to the carceral setting. The instrument included structured tables listing all menu items by meal (breakfast, lunch, and dinner), allowing participants to indicate the foods and proportions consumed (none, less than half, about half, more than half but not all, all, or more than one serving). Additional items captured the type and quantity of foods obtained and consumed from the commissary. Participants completed the food intake questionnaire over a 4-day period. At the end of the four days, participants provided feedback on the questionnaire's appropriateness and feasibility during group listening sessions. Verbal and written feedback was compiled and coded to identify common themes. Daily total and mean caloric, macronutrient, and micronutrient intakes were estimated using NutritionCalc Plus® and compared to appropriate Dietary Reference Intakes. Of the 65 people recruited, 64 agreed to participate in the study and 61 participants completed all four days of the questionnaire. Participants reported that they enjoyed reflecting on their diets and recommended several modifications to the questionnaire design to improve accuracy when documenting intake. Women reported consuming excess total calories and men reported consuming deficient total calories. Macronutrient consumption was within the recommended ranges for men and women, while sodium exceeded healthy recommendations. Participants also reported consuming inadequate amounts of fruits, vegetables, and minerals. With specific modifications to improve documentation accuracy, the food intake questionnaire can be used in future research assessing nutritional status in jails, prisons, and other controlled food environments.
Hepatitis C virus (HCV) infection is highly prevalent in U.S. jails, yet access to curative direct-acting HCV therapy remains limited because of the inmate Medicaid exclusion rule. However, an innovative expansion of the AIDS Drug Assistance Program in California now supports HCV treatment for individuals experiencing incarceration who are living with HIV. We describe the implementation of this pilot program in the Los Angeles County Jail, including the formation of a multidisciplinary task force designed to rapidly identify, evaluate, and initiate treatment despite the unpredictable length of stay and other barriers. Enabling treatment delivery within jail constraints has been possible with program adaptations such as provision of remaining HCV medications at release, shortened regimens and use of early sustained virologic response. Although challenges remain-including lack of universal screening, no funding for treatment of HCV monoinfection, and limited post-release linkage to care-this pilot demonstrates that targeted policy innovation combined with an effective implementation team can expand access to lifesaving HCV care in carceral settings in a group at very high risk.
The U.S. carceral health care system presents a unique opportunity to expand reproductive health services. Evidence suggests that women incarcerated in jails want to initiate contraception, but access varies across facilities and is limited by concerns about cost, reproductive coercion, and a lack of consistent policies. To better understand the reproductive health needs of rural incarcerated women, a cross-sectional study of women incarcerated in four rural Maine jails was conducted using a 59-question survey on contraceptive history, needs, and preferences. Seventy-three women with complex histories of trauma, substance use, and poor reproductive health outcomes completed the survey. There were low rates of contraceptive use prior to incarceration. Thirty-nine percent plan to use contraception following release despite only 15% desiring pregnancy. Most respondents felt that women incarcerated in jails should have access to permanent sterilization but were concerned about coercion.
Correctional facilities were disproportionately affected by SARS-CoV-2 (COVID-19) outbreaks. Wastewater surveillance programs (WSP) may provide early warnings of the presence of COVID-19 and facilitate the timely implementation of infection mitigation, but their budgetary implications for correctional systems remain unclear. We conducted an activity-based costing analysis of a pilot WSP in a large urban jail. Costs borne by the jail were assessed and included start-up investments, implementation expenditures, and the costs of confirmatory polymerase chain reaction testing (PCR test). We developed budget impact scenarios based on the number of outflow points testing positive and the confirmatory testing required in the cellblocks linked to them. We also conducted a scenario analysis using rapid antigen tests in place of PCR tests. Initial start-up costs totaled $29,471. Implementation costs for testing a single outflow point, linked to seven cellblocks, were $16,802, with PCR-testing accounting for 78% of expenditures. Implementation costs varied from $4,403 for zero positive outflow tests to $125,965 for eight positive outflow tests. Use of rapid antigen tests reduced costs significantly. Adoption of wastewater surveillance with confirmatory testing in correctional settings may entail substantial costs. The budget impact is likely to be highly sensitive to confirmatory test type, sewer configuration, and the specificity of the wastewater sample to a location. These findings underscore the need for correctional administrators to investigate feasibility and affordability when considering the use of WSP to help protect incarcerated populations from infectious disease threats.
Opioid use disorder is prevalent among incarcerated populations, who face elevated overdose risk post-release. Although effective, buprenorphine remains underutilized in U.S. jails, particularly in the South. This mixed-methods study evaluated clinical outcomes and implementation processes of a jail-based buprenorphine program in Appalachia. The State Department of Health piloted a model using telehealth prescribing and post-release navigation. Guided by the Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change, qualitative interviews with five program staff identified implementation barriers and facilitators. Retention outcomes were strong and comparable to community benchmarks. Barriers included staff skepticism, stigma, limited capacity, and role ambiguity, while facilitators included sustained education, leadership engagement, and cross-agency collaboration. Findings demonstrate feasibility in resource-constrained southern settings and highlight strategies to sustain and expand buprenorphine access for justice-involved populations.
Despite strong evidence that sustained engagement in OUD treatment reduces overdose risk, individuals leaving jail face substantial barriers to initiating and maintaining care. Motivational interventions such as motivational interviewing (MI) are commonly used during this reentry period to enhance engagement. While MI effectively targets internal readiness to change, it is less clear how such approaches operate in the presence of persistent structural barriers. This study explores how social determinants of health (SDOH) factors shaped participant engagement during a motivational intervention following release from jail. We conducted a qualitative content analysis of 500 clinical case notes generated by personnel facilitating linkage to treatment for participants (n = 155) with OUD and recent criminal legal system involvement. Notes were generated during a clinical trial (NCT04365920, Registered 2019-12-19) of Recovery Management Checkups (RMC); RMC is an evidence-based intervention that uses ongoing “check-up” meetings grounded in MI to link individuals to substance use treatment and support their treatment retention and recovery, or re-link them to treatment as needed. Case notes were coded according to a framework adapted from the Centers for Disease Control and Prevention’s SDOH domains, and categorized as either facilitators or barriers to participants’ treatment engagement. Findings highlighted economic stability as the most frequently cited barrier to treatment engagement, particularly housing instability, unemployment, and lack of transportation. Other barriers included poor physical health, legal constraints, and negative social influences. Facilitators included support from family and community, healthcare access, mutual aid involvement, and religious engagement. Results revealed how social and structural barriers impede treatment engagement within the context of a motivational-based linkage intervention. These findings underscore the need for integrated approaches that acknowledge both motivational readiness and the structural realities of participants' lives. Interventions may benefit from pairing motivational strategies with practical supports (e.g., transportation, housing navigation, harm-reduction planning). Given the challenges intervention staff face when attempting to help individuals in low-resource environments, implications for supporting personnel delivering motivational strategies are discussed.
Access to prison healthcare and healthcare equity remains poorly understood in the Philippines. With Philippine jail health systems subjected to budgetary restrictions, optimization of efficient mechanisms in healthcare delivery is warranted. This makes understanding how PDLs' utilization to healthcare services more relavant and of high importance. This study sought to determine healthcare accessibility and explored what influences healthcare access by Persons Deprived of Liberty (PDLs). Additionally, the study looked into whether healthcare was equally accessible to different PDL subgroups. A descriptive-correlational design was employed in recruiting 261 PDLs utilizing stratified random sampling in two jail facilities in Dumaguete City from May to June 2023. Data on healthcare accessibility and availability from self-report survey questionnaires were analyzed using SPSS version 25. Hierarchical linear regression analysis shows that, collectively, predisposing factors (age, sex) F=200.82, enabling resources (availability of health services) F=52.52, and perceived needs (physical activities, sleep, diet, and mental health) F=30.24 significantly predict healthcare accessibility, having the availability of healthcare services as the strongest predictor with an R2 change of 43.7% followed by percieved needs (3.9%) and predisposing factor (1.4%), respectively. Furthermore, ordinal logistic regression analysis shows that healthcare by age groups 18-34 (OR=0.379) and 35-54 (OR=0.449) are less likely to be available and accessed than those aged 55 and above. Additionally, availability and accessibility of healthcare are less likely for males (OR=0.24) than females while PDLs with average physical activities (OR=0.87), good (OR=50.7) to average sleep (OR=27.4), and average mental health (OR=0.35) have higher odds of availing and accessing healthcare than their poor counterparts. These findings indicate that PDLs tend to access healthcare services based predominantly on availability rather than their desired needs warranting strategies that allow catering to a wide range of health needs in PDL subgroups which ultimately lead to better prison health outcomes.
This cross-sectional study quantifies access to methadone for incarcerated people in the US in terms of distance between jails and opioid treatment programs.
The Inmate Navigation, Enrollment, Support, and Treatment (INVEST) program is a reentry intervention for persons who are detained with co-occurring mental health and substance use disorders. In a randomized controlled trial, 202 adults were assigned to either INVEST or standard reentry services. INVEST combined peer support, case management, and cognitive behavioral treatment during and after incarceration. Participants who successfully completed INVEST had significantly better outcomes: fewer rebookings, fewer days in jail, and more time in the community. Gains were found in access to support, resource use, and reduced stress around housing and justice obligations. Study limitations included low 6-month follow-up response rates, incomplete information on resource access at follow-up, and a lack of documented detail regarding services available to the comparison group after release. Because implementation occurred within a single jurisdiction, findings should be interpreted with caution in terms of broader applicability. Even with these constraints, results highlight the promise of integrated, peer-supported reentry approaches and underscore that effective reentry requires strengthening participants' recovery capital and sustained engagement-not solely expanding service availability.
Over the past three decades, court-mandated drug treatment has emerged as a popular strategy to manage drug-related crime and substance use disorder (SUD). These programs offer dismissal or reduction of criminal charges upon satisfactory completion of drug treatment and additional conditions such as negative urine screenings, as determined by the criminal-legal system. Treatment modalities utilized via mandated treatment programs vary substantially across jurisdictions in the intensity and format of treatment. This variation can be explained in part by differences in state-level sentencing policies and the landscape of drug treatment and social services. We analyzed 27 qualitative individuals with Black and Hispanic individuals recruited from metropolitan areas in 3 US states who had received court-mandated treatment. Interviews were analyzed using a hybrid deductive-inductive approach to examine common challenges and diverging experiences of mandated treatment. Our analysis highlights intrinsic motivation, perceived agency, and perceived quality of care as key determinants of the effectiveness of mandated treatment on long-lasting behavioral change. Findings suggest there is a need to increase the emphasis on service quality within mandated treatment, including the utilization of evidence-based practices. This will require reframing success within mandated treatment programs from quantitative metrics, such as treatment attendance, to include qualitative metrics, such as level of therapeutic engagement.
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BackgroundPregnant and postpartum incarcerated women are at risk of adverse health outcomes due to pre-incarceration risks and exposures during incarceration.ObjectivesThis study characterized maternal healthcare and neonatal outcomes among incarcerated pregnant women in Georgia from August 2020 to March 2025.DesignWe utilized a sequential mixed methods approach using data from a birth cohort of children exposed prenatally to incarceration in Georgia.MethodsWe analyzed qualitative data on maternal care experiences from 41 mothers and quantitative data on neonatal outcomes from caregivers of 84 children. Qualitative results informed exploratory tests of group differences for neonatal outcomes (i.e.,mode of delivery, neonatal complications, low birthweight) and breastfeeding initiation between (1) those who gave birth in the community compared to during incarceration; (2) those who were incarcerated in jail as compared to prisons.ResultsParticipants described low-quality maternal healthcare, inhumane treatment, and lack of safety and comfort, and the use of practices like solitary confinement and shackling. Fisher's exact tests were significant for differences in breastfeeding initiation between those who gave birth in the community compared to those who gave birth during incarceration (p = 0.002), but breastfeeding initiation did not differ between those who were incarcerated in jail as compared to prison. Mode of delivery, neonatal complications, and low birthweight did not significantly differ between those who gave birth in the community compared to those who gave birth during incarceration nor those who were incarcerated in jail as compared to in prisons.ConclusionsIncarcerated pregnant and postpartum women in Georgia report low-quality maternal healthcare. Policy leaders should establish evidence-based policies for maternal healthcare within prisons and jails and consider community-based alternatives to incarceration for pregnant women. This study looked at the health care experiences of pregnant and postpartum women while they are in jail or prison in Georgia, as well as the health of their newborn babies. The research was done between August 2020 and March 2025. The study included 41 mothers who talked about their experiences with medical care during pregnancy and after birth while incarcerated. It also included data about babies born to 84 mothers who were in jail or prison while pregnant. Many women reported receiving poor-quality health care while incarcerated. They described feeling unsafe, being treated inhumanely, and sometimes being put in solitary confinement or shackled, even during pregnancy or childbirth. These practices can be very harmful for both the mother and the baby. Researchers compared the health of babies born to mothers who gave birth while incarcerated with those who gave birth in the community (not in jail or prison). They found that mothers who gave birth in the community were more likely to start breastfeeding their babies. The study highlights that pregnant and postpartum women in Georgia’s jails and prisons are not receiving the quality of care they need. Based on these findings, the authors recommend that policy makers should create better, evidence-based policies to support pregnant women in jail or prison. They also suggest that instead of putting pregnant women in jail or prison, community-based alternatives should be considered to protect the health and well-being of both mothers and their babies. In summary, the study shows that improving maternal healthcare in jails and prisons and considering alternatives to incarceration for pregnant women are important steps toward healthier outcomes for mothers and their children.
Individuals released from jail die by self‑harm at nearly nine times the rate of the general U.S. Most jails rely on traditional screening methods, such as brief self-report questionnaires, which are often inconsistently administered and have limited sensitivity and predictive accuracy. This highlights the urgent need for alternative self-harm risk identification methods during and after incarceration. To evaluate the feasibility of applying an existing self-harm risk prediction model to jail populations. We analyzed data from 4,154 individuals incarcerated in Michigan jails who were enrolled in Medicaid. We applied a prediction model, originally developed by the Mental Health Research Network (MHRN), to identify individuals at elevated risk for self-harm. Predictors included demographics, mental health and substance use diagnoses, medical comorbidities, prior history of self-harm, mental health-related hospitalizations, and dispensing of psychotropic medications. The study cohort was predominantly male (70%) and racially diverse (50% Black, 43% White), with a median jail stay of just one day. Overall, the model demonstrated good discrimination, achieving a C-statistic of 0.77, with 68% sensitivity and 77% specificity, and a 99% negative predictive value. Notably, among individuals with shorter jail stays, predictive performance was better, with the C-statistic increasing to 0.80. Health records-based models demonstrated good predictive performance and may offer a scalable, data-driven alternative to traditional screening tools in jails. Integrating health records-based risk prediction tools in jails could improve early detection of self-harm risk and support more targeted prevention efforts.
This project evaluates a Hepatitis C (HCV) treatment model in a county jail setting in Asheville NC. A regional nonprofit community clinic, local county detention center, care coordination community-based organization and regional harm reduction organization (HRO) collaborated. Between April 2024 and March 2025 six semi-structured interviews with representative stakeholders were conducted to identify stakeholder-perceived barriers and potential solutions. Interviews were transcribed and coded by two coders. Results showed barriers related to jail setting, staffing, and funding frequently mentioned by interviewees. Interagency partnerships, shared workflows and case management were crucial components for successful treatment model implementation. Jails remain underutilized for HCV intervention. With appropriate resources, treatment in this setting is feasible. Innovative, community driven models can significantly contribute to HCV elimination and improve public health within the carceral system and in communities. The results of this project indicate that the future policymaking should target jail settings in efforts to decrease disease transmission and the burden of the HCV in Western North Carolina and beyond.