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Evolução do estado de saúde em reclusas : estudo dos registos clínicos

Cerqueira, Ana Raquel Rego da Silva
Fonte: Universidade do Minho Publicador: Universidade do Minho
Tipo: Trabalho de Conclusão de Curso
Publicado em //2012 POR
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Dissertação de mestrado integrado em Psicologia (área de especialização em Psicologia da Saúde); O ambiente prisional é um caso particular de concentração de pessoas numa instituição, que está associada a situações de frustração, violência, falta de esperança no futuro, perspectivas de novo encarceramento, ruptura de laços sociais e familiares e continuação de consumo de drogas. De acordo com Crofts (1997) e Levy (1999) esta combinação fomenta elevados comportamentos de risco para a saúde, a dependência de drogas e perturbações mentais (Observatório Português dos Sistemas de Saúde, 2003). Se as condições de reclusão podem propiciar problemas de saúde física e mental, também é reconhecido que no momento de reclusão estas pessoas podem ter condições de saúde mais frágeis. Quando se trata especialmente da população feminina, a maioria da população reclusa feminina advém de famílias carenciadas, onde as desigualdades sociais sobressaem, reflectindo-se num estado de saúde precário. Isto significa que a prisão pode ser uma oportunidade para estas mulheres receberem cuidados de saúde adequados. Alguns estudos têm procurado caracterizar o estado de saúde de mulheres reclusas recorrendo ao relato que elas fazem da sua saúde...

Research on the Caretaking of Children of Incarcerated Parents: Findings and Their Service Delivery Implications

Hanlon, Thomas E.; Carswell, Steven B.; Rose, Marc
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /03/2007 EN
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This paper reviews research findings on caretaking-related problems associated with the absence of parents from the home following incarceration. It focuses on the impact of incarceration on the welfare and adjustment of urban African American children and on the assumption of caretaking responsibilities by other caretakers, principally maternal grandmothers. Noting the complex situational difficulties involved and the potential burdens associated with surrogate parenting in general, and with this population in particular, the service-provider implications of this parenting arrangement are considered in this review. Findings indicate that problems associated with incarceration of parents tend to be intergenerational and vary considerably in complexity and severity. To the extent that they impact the children involved, these issues should be addressed in coordinated service delivery focusing on prevention.

Deaths in the Cook County Jail: 10-Year Report, 1995–2004

Kim, Seijeoung; Ting, Andrew; Puisis, Michael; Rodriguez, Sergio; Benson, Roger; Mennella, Connie; Davis, Faith
Fonte: Springer US Publicador: Springer US
Tipo: Artigo de Revista Científica
EN
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The aims of this study were to describe causes of death during the 10-year period between 1995 and 2004 in a large urban jail in Chicago; to compare disease specific mortality rates between the jail population and the general population; to explore demographic and incarceration characteristics of the inmates who died in the jail by cause of death; and to examine gender difference in demographic characteristics, incarceration patterns, and causes of death. A total of 178 deaths occurring in the jail over a 10-year period (1995–2004) were reviewed. Age-adjusted disease-specific mortality rates were computed for the jail population and compared with the rates in the US general population. Cause of death, demographic variables, and incarceration related factors were retrieved from multiple computerized databases. Descriptive analyses were performed to examine demographic and incarceration-related patterns by cause of death and gender. Heart disease was the most frequent cause of death in the jail population, followed by cerebrovascular disease and suicide. Mortality rates for heart diseases, infectious/inflammatory conditions and suicide were higher for jail inmates than the general population. Black inmates accounted for the majority of deaths due to illnesses and homicide...

Housing Patterns and Correlates of Homelessness Differ by Gender among Individuals Using San Francisco Free Food Programs

Riley, Elise D.; Weiser, Sheri D.; Sorensen, James L.; Dilworth, Samantha; Cohen, Jennifer; Neilands, Torsten B.
Fonte: Kluwer Academic Publishers-Plenum Publishers Publicador: Kluwer Academic Publishers-Plenum Publishers
Tipo: Artigo de Revista Científica
EN
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Homeless individuals experience high rates of morbidity and mortality, yet many homeless studies include small percentages of female participants. We therefore sought to determine correlates of homelessness separately for men and women in a sample of individuals visiting free food programs. Between August 2003 and April 2004, 324 individuals were recruited from San Francisco free food programs and interviewed regarding housing, sociodemographics, health, drug use, sex trade, and incarceration. Over one-half of women and almost three-fourths of men reported homelessness in the prior year. Among women, white race, younger age, not living with minor children, engaging in sex trade and recent incarceration were strongly associated with homelessness; however, only incarceration maintained the strong association in adjusted analysis (OR = 7.16, CI = 3.83–13.4). Among men, heavy alcohol use, drug use, years spent living in San Francisco and monthly income were strongly associated with homelessness; however, only years living in San Francisco (OR = 0.28, CI = 0.19–0.42) and monthly income maintained strong association in adjusted analysis (OR = 0.27, CI = 0.13–0.57). Housing patterns and the strongest correlates of homelessness among individuals visiting free food programs differ by sex. These results suggest the need to characterize homelessness and develop effective homeless interventions separately for men and women.

Recidivism in HIV-Infected Incarcerated Adults: Influence of the Lack of a High School Education

White, Mary C.; Marlow, Elizabeth; Tulsky, Jacqueline P.; Estes, Milton; Menendez, Enrique
Fonte: Springer US Publicador: Springer US
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
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Recidivism is a pervasive problem facing the incarcerated. Incarcerated persons who are human immunodeficiency virus (HIV)-infected often have multiple risk factors associated with initial incarceration and recidivism, in particular, injection drug use. Yet, some jails provide case management for HIV-infected inmates to provide continuity of health care, which might have positive effects on reentry into the community. We sought to measure recidivism and factors related to recidivism in an HIV-infected cohort in an urban county jail with an active case management program. Fifty-two inmates surveyed in 1999 at the San Francisco County Jail were followed for rearrests through 2006. In follow-up, 73% were re-incarcerated on an average of 6.8 times for 552 days. Risk factors included nonwhite ethnicity, history of homelessness and crack use, common risk factors for incarceration. Less than high school education was associated with recidivism, shorter time to reincarceration, and more incarcerations. HIV-infected inmates spend a high proportion of time in multiple incarcerations, a reflection of the cyclical nature of incarceration despite comprehensive case management. Well-known risk factors for incarceration were associated with recidivism; in addition...

A Test of Problem Behavior and Self-Medication Theories in Incarcerated Adolescent Males

Esposito-Smythers, Christianne; Penn, Joseph V.; Stein, L. A. R.; Lacher-Katz, Molly; Spirito, Anthony
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 01/08/2008 EN
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The purpose of this study is to examine the problem behavior and self-medication models of alcohol abuse in incarcerated male adolescents. Male adolescents (N = 56) incarcerated in a juvenile correction facility were administered a battery of psychological measures. Approximately 84% of adolescents with clinically significant alcohol-related problems prior to incarceration indicated use of alcohol for purposes of self-medication and 73% indicated that their alcohol use was associated with aggressive and rebellious behavior. Further, adolescents with clinically significant alcohol-related problems prior to incarceration reported higher levels of affective symptoms, mood-related cognitive distortion, and less use of social support during incarceration than adolescents without clinically significant alcohol-related problems. They also reported more symptoms associated with oppositional defiant but not conduct disorder. For the majority of incarcerated male adolescents in this sample, alcohol-related problems appeared to be associated with both self-medication and problem behavior. Incarcerated adolescents with a history of alcohol-related problems may require skills training in addition to substance abuse services to address affective symptoms and coping skill deficits.

Assessing criminal justice involvement as an indicator of HIV risk among women in methadone treatment

Epperson, Matthew W.; Khan, Maria R.; Miller, Daniel P.; Perron, Brian E.; El-Bassel, Nabila; Gilbert, DSW Louisa
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
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This study examines the relationship between criminal justice involvement and high-risk sexual partnerships among a random sample of 416 women in methadone treatment in New York City. Logistic regression models were used to estimate the associations between recent criminal justice involvement (arrest or incarceration in the past 6 months) and recent high-risk partnerships (multiple sex partners, sex trading, or sex with a risky partner in the past 6 months) when adjusting for sociodemographic factors and recent regular drug use. Women with recent criminal justice involvement demonstrated higher odds of engaging in high-risk sex partnerships. Although regular drug use was a significant confounder of several of these relationships, recent arrest or incarceration remained significantly associated with multiple sex partnerships, sex with a risky partner, and engaging in unprotected sex and a high-risk partnership even after controlling for regular drug use and other social stressors. This study highlights the vulnerability of drug-involved women offenders to HIV risk and points to the need for investigation into the role of arrest and incarceration as factors that may contribute to HIV infection.

Increased HIV Risk Associated with Criminal Justice Involvement among Men on Methadone

Epperson, Matthew; El-Bassel, Nabila; Gilbert, Louisa; Orellana, E. Roberto; Chang, Mingway
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
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This paper examines the relationship between HIV risk and criminal justice involvement among a random sample of 356 men enrolled in methadone maintenance treatment programs in New York City. Bivariate and logistic regression analyses were performed to estimate the associations between measures of criminal justice involvement and participant HIV risk, controlling for socio-demographic variables. A lifetime history of incarceration was significantly associated with being HIV positive (Adjusted OR = 5.08). Recent arrest was associated with unprotected vaginal sex and having multiple female sexual partners. Sex trading was associated with both arrest and incarceration, and the strongest association was found between selling sex and recent incarceration (Adjusted OR = 5.69). Results suggest that recent criminal justice involvement among men with substance abuse histories is associated with increased HIV risk behaviors. Findings underscore the need for targeted HIV prevention efforts for men on methadone with a recent history of arrest or incarceration.

Childhood Predictors of Young Adult Male Crime

Ou, Suh-Ruu; Reynolds, Arthur J.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 01/08/2010 EN
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The study sample was drawn from the Chicago Longitudinal Study (CLS), an ongoing investigation of a panel of low-income minority children (93% Black) growing up in high-poverty neighborhoods in Chicago. The study sample included 733 males who were active by age 26. Adult criminal records were collected through administrative records and supplemented with self-reports. Outcome measures included incarceration, conviction, and felony conviction by age 26. Probit regression was used to analyze the data. Findings indicated that common childhood predictors were AFDC participation by child’s age 3, negative home environment, maltreatment experience, trouble making behavior, and number of school moves. Unique predictors were mother unemployed by child’s age 3 for incarceration or jail, four or more children in household by child’s age 3 for felony conviction, and mother did not complete high school by child’s age 3 and social competence for both incarceration or jail and felony conviction. Implications on crime prevention were discussed.

Prisoner Survival Inside and Outside of the Institution: Implications for Health-Care Planning

Spaulding, Anne C.; Seals, Ryan M.; McCallum, Victoria A.; Perez, Sebastian D.; Brzozowski, Amanda K.; Steenland, N. Kyle
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
EN
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The life expectancy of persons cycling through the prison system is unknown. The authors sought to determine the 15.5-year survival of 23,510 persons imprisoned in the state of Georgia on June 30, 1991. After linking prison and mortality records, they calculated standardized mortality ratios (SMRs). The cohort experienced 2,650 deaths during follow-up, which were 799 more than expected (SMR = 1.43, 95% confidence interval (CI): 1.38, 1.49). Mortality during incarceration was low (SMR = 0.85, 95% CI: 0.77, 0.94), while postrelease mortality was high (SMR = 1.54, 95% CI: 1.48, 1.61). SMRs varied by race, with black men exhibiting lower relative mortality than white men. Black men were the only demographic subgroup to experience significantly lower mortality while incarcerated (SMR = 0.66, 95% CI: 0.58, 0.76), while white men experienced elevated mortality while incarcerated (SMR = 1.28, 95% CI: 1.10, 1.48). Four causes of death (homicide, transportation, accidental poisoning, and suicide) accounted for 74% of the decreased mortality during incarceration, while 6 causes (human immunodeficiency virus infection, cancer, cirrhosis, homicide, transportation, and accidental poisoning) accounted for 62% of the excess mortality following release. Adjustment for compassionate releases eliminated the protective effect of incarceration on mortality. These results suggest that the low mortality inside prisons can be explained by the rarity of deaths unlikely to occur in the context of incarceration and compassionate releases of moribund patients.

Mother–Grandmother Coparenting Relationships in Families with Incarcerated Mothers: A Pilot Investigation

BAKER, JASON; McHALE, JAMES; STROZIER, ANNE; CECIL, DAWN
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/2010 EN
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Using new methods designed to assess coparenting between incarcerated mothers of preschool-aged children and the maternal grandmothers caring for the children during their absence, we examined relationships between coparenting quality during the mother’s jail stay and both concurrent child behavior problems and later coparenting interactions following mothers’ release and community reentry. Forty mother–grandmother dyads participated in joint coparenting discussions during the incarceration, with a smaller subset completing a parallel activity at home 1 month postrelease. Both women also participated in individual coparenting interviews during the incarceration, and reported on child behavior problems. Mother–grandmother coparenting interactions exhibited an overall structure similar to that documented in nuclear families, with population-specific dynamics also evident. The observational system demonstrated good interrater and internal reliability, and showed associations with maternal (but not grandmother) reports and descriptions of the coparenting relationship via interview. Greater coparenting relationship quality during incarceration was associated with fewer concurrent child externalizing behavior problems, and predicted more positive coparenting interactions postrelease. Findings suggest that the coparenting assessments were useful for under-standing mother–grandmother coparenting relationships in these families and that importantly...

Considerations in HIV Prevention for Women Affected by the Criminal Justice System

Kramer, Katie; Comfort, Megan
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
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Within the national dialogue of HIV prevention strategies, relatively little consideration is given to the millions of women and girls affected by the criminal justice system either through their own incarceration or that of their partners. Yet statistics indicate that these women and girls are disproportionately infected or at risk for HIV and other sexually transmitted infections and much of this risk is directly related to the dynamics and circumstances that led to their incarceration or relationships with incarcerated men. As we look for the link between public health and correctional health within our National HIV/AIDS Strategy, it is imperative that the risks, obstacles, and opportunities facing women and girls affected by incarceration are brought into the discussion. Gender responsive HIV prevention policies and practices must be developed to address the unique risks and opportunities for these women and girls. This paper presents data on HIV risk and other health issues specific to this community of women and girls, discusses key factors for consideration when developing gender-responsive HIV strategies for these communities, and makes recommendations for inclusion in the National HIV/AIDS Strategy and other state and local HIV prevention efforts.

The Persistence of HIV Risk Behaviors Among Methamphetamine-Using Offenders†

Cartier, Jerome J.; Greenwell, Lisa; Prendergast, Michael L.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /12/2008 EN
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Studies have shown that methamphetamine (MA) is rapidly becoming the drug of choice for a large number of substance-abusing offenders and is associated with significantly higher levels of HIV risk behaviors prior to their incarceration. Despite these findings, there has been little follow-up research to determine whether these patterns persist among recently paroled offenders after attendance in an in-prison treatment program. This study uses the self-reported data from 812 substance-abusing offenders in a multisite NIDA-funded project to determine whether, either before incarceration or nine months after release from an in-prison substance abuse program, MA use in the past 30 days was associated with increased HIV risk behaviors. The findings indicate that offenders who used MA prior to and after incarceration and treatment report higher levels of HIV risk behaviors compared with offenders with no MA use. Clinical and policy implications of the findings are discussed.

Patterns of Crime and Drug Use Trajectories in Relation to Treatment Initiation and 5-Year Outcomes: An Application of Growth Mixture Modeling Across Three Datasets

Prendergast, Michael; Huang, David; Hser, Yih-Ing
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /02/2008 EN
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Drug abusers vary considerably in their drug use and criminal behavior over time, and these trajectories are likely to influence drug treatment participation and treatment outcomes. Drawing on longitudinal natural history data from three samples of adult male drug users, we identify four groups with distinctive drug use and crime trajectories over the 5 years prior to their first treatment episode. The groups’ characteristics of initial treatment are compared. The trajectory groups are then included in Poisson growth curve models to predict drug use, incarceration, and employment over the 5 years following first treatment. Findings indicate that posttreatment drug use decreased and posttreatment employment increased. There was little change in posttreatment incarceration. Posttreatment trajectories for drug use, incarceration, and employment were significantly different across the four trajectory groups.

The Brief Self-Control Scale Predicts Jail Inmates’ Recidivism, Substance Dependence, and Post-Release Adjustment

Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
17.33%
Previous research finds that self-control is positively associated with adaptive and negatively associated with maladaptive behavior. However, most previous studies employ cross-sectional designs, low-risk samples, and limited assessments of self-control. This study of 553 jail inmates examined the relationship of a valid measure of self-control (Brief Self-Control Scale; BSCS) completed upon incarceration with behavior before, during, and one year after incarceration. After controlling for positive impression management (PIM), self-control was negatively related to substance misuse, suicidality, risky sex, and criminal history prior to incarceration and post-release illegal substance misuse, recidivism, and positive adjustment. Lower self-control predicted increases in substance dependence at post-release compared to pre-incarceration. Self-control was not related to misbehavior during incarceration, nor alcohol use or HIV-risk behavior one year post-release. Results were consistent as a function of age, race, and gender. This study supports self-control as an important risk and protective factor in a sample of criminal offenders.

Maternal partner criminality and cannabis use in young adulthood: Prospective study

Hayatbakhsh, M.; Kinner, S.; Jamrozik, K.; Najman, J.; Mamun, A.
Fonte: Blackwell Publishing Asia Publicador: Blackwell Publishing Asia
Tipo: Artigo de Revista Científica
Publicado em //2007 EN
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Objectives: The present study examined whether the experience of the arrest or incarceration of a mother's partner before a child reached 14 years of age was associated with use of cannabis in early adulthood and, if so, whether this association was confounded or mediated by other factors. Method: Data were from the Mater Hospital University of Queensland Study of Pregnancy, a prospective birth cohort study in Brisbane, Australia. The history of partner arrest and incarceration was reported by mothers at the 14 year follow up. Mothers were divided into four groups: mothers whose partner had no history of arrest or incarceration, mothers reporting partner arrest, mothers reporting partner incarceration, and unpartnered mothers. Young adults' cannabis use was assessed at 21 years. Other covariates were prospectively measured between birth and 14 years. Results: After controlling for potential confounding and mediating factors, frequent use of cannabis at age 21 was more likely among young adults with a history of maternal partner arrest (odds ratio=2.3; 95% confidence interval: 1.4-3.8). There was no significant association between maternal partner incarceration or single motherhood, and cannabis use at age 21. Conclusions: Arrest of the mother's partner before the child is 14 is associated with that child's increased cannabis use at age 21 but this does not appear to be the case for children whose fathers have been imprisoned. It appears that for children whose fathers have been arrested...

Des jeux de hasard et d'argent en détention? L'état de la situation dans les pénitenciers fédéraux du Québec

Beauregard, Valérie
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
FR
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À la base, les jeux de hasard et d’argent (JHA) se révèlent pour la grande majorité des gens une activité ludique agréable. On les associe effectivement aux loisirs, puisqu’ils répondent pratiquement aux mêmes besoins, dont la curiosité, le divertissement, la détente, la socialisation et la reconnaissance (Chevalier, 2003; Chevalier & Papineau, 2007; Paradis & Courteau, 2003). En contrepartie, ils constituent tout de même un risque d’excès. Bien que personne ne soit vraiment à l’abri de la dépendance, les écrits scientifiques montrent que certains groupes se révèlent particulièrement à risque. Avec les personnes qui souffrent de troubles mentaux et toxicomaniaques (Walters, 1997), la population correctionnelle se trouve parmi les individus les plus susceptibles de présenter des problèmes liés au jeu pathologique (Abbott, McKenna, & Giles, 2005; Ashcroft, Daniels, & Hart, 2004; Lahn, 2005). Or, si plusieurs études informent sur les habitudes de jeu précarcérales des hommes condamnés à l’emprisonnement, peu renseignent sur ce qu’il advient de cette pratique à l’intérieur des établissements de détention. Malgré une interdiction formelle des services correctionnels, on reconnaît pourtant la présence des JHA en prison (Abbott et al....

The US Crime Puzzle: A Comparative Perspective on US Crime & Punishment

Spamann, Holger
Fonte: Harvard University Publicador: Harvard University
Tipo: Research Paper or Report
EN_US
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This paper compares actual US crime and incarceration rates to predicted rates from cross-country regressions. Global cross-country regressions of crime and incarceration on background characteristics explain much of the variation between other countries. But the estimated models predict only one-fourth of US incarceration and not all of US crime. The coincidence of the non-negative US crime residuals with the very large positive US incarceration residual constitutes a puzzle. The two pieces fit together only if the residual US incarceration does not contribute to a reduction in crime, except to the extent an omitted criminogenic factor pushes up US crime. The paper quantifies this relationship. Drawing on additional evidence from comparative and US-specific data, it argues that the puzzle's most plausible solution combines low effectiveness of mass incarceration with omitted criminogenic factors such as neighborhood segregation.

Points de vue de femmes incarcérées dans des établissements fédéraux concernant les impacts du contexte carcéral sur leur trajectoire de consommation de drogues

Plourde, Chantal; Brochu, Serge; Couvrette, Amélie; Gendron, Annie
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Artigo de Revista Científica
FR
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La consommation de substances psychoactives (SPA) chez les femmes détenues ne fait que très rarement l’objet de recherches. Pourtant, l’usage de SPA chez les femmes judiciarisées avant leur incarcération est fréquent. Le matériel qualitatif traité dans le cadre de cet article de même que les analyses qui en découlent visent à améliorer notre compréhension des trajectoires de consommation des femmes incarcérées et à aborder des dimensions essentielles de la vie de ces femmes qui méritent d’être mieux comprises des intervenants et des chercheurs. À partir d’une recherche à devis mixte s’intéressant aux trajectoires de consommation des femmes détenues (avant et pendant l’incarcération) dans cinq établissements carcéraux du Canada, trois thèmes reliés à l’expérience d’enfermement carcéral en rapport avec la consommation de drogues ont émergé des discours : le moment charnière, la trêve, les blâmes. L’exercice fut réalisé à partir des propos de 38 femmes ayant à la fois affirmé éprouver un quelconque problème avec l’alcool ou une autre drogue avant leur incarcération et ayant abordé spontanément la question de l’effet de l’incarcération sur leur cheminement en regard de la consommation.; Substance use amongst women inmates has rarely been a subject of research. Yet...

Medicaid Coverage for Inmates and Reentering Populations in North Carolina

Ellen, Whelan-Wuest
Fonte: Universidade Duke Publicador: Universidade Duke
Tipo: Masters' project
Publicado em 20/04/2012 EN_US
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As part of the Patient Protection and Affordable Care Act (PPACA), Medicaid will expand in 2014 to extend eligibility for health care coverage to millions more Americans. Included among these will be those prison inmates and ex-offenders who are currently ineligible for Medicaid coverage. Corrections systems are constitutionally mandated to provide adequate health care to all prison and jail inmates for the duration of their incarceration. The expenses associated with providing this care are a leading cost driver for most state correctional systems. As states continue to battle large budget deficits, elected officials and agency leadership are increasingly motivated to reduce high prison costs. North Carolina is no exception, and in 2010 the General Assembly issued a directive compelling the state Department of Correction (DOC) to identify and implement new cost-saving measures. The result was the implementation of a new Inmate Medicaid Enrollment (IME) program that became operational in February 2011. According to internal estimations, this new program was projected to save DOC $14 million by the end of the 2011-2012 fiscal year. IME also represents a uniquely successful cross-collaboration between two large state agencies with no prior working relationship- DOC and the State Department of Medical Assistance (DMA). As more states consider similar inmate Medicaid utilization programs...