Journal of Correctional Health Care

A 2-day academic and health policy conference on correctional health was held in March 2007. During this conference, several intensive workshops were conducted with the goal of bringing together correctional health experts, clinicians, and researchers to identify important research areas that require investigation to improve inmate health. This article summarizes the focused discussion on infectious diseases. Results of this workshop suggested that research is needed on testing procedures (HIV and HCV), sexual behavior and risks during incarceration, the use of existing clinical data (secondary analyses), and evaluation of corrections-specific education materials on HIV and HCV. Finally, a forum for correctional health researchers to share study findings and to develop multisite research relationships is urgently needed.

In March 2007, a national work group met to review the state of mental health research in correctional settings. Participants identified gaps in current knowledge and topics most in need of further research. The discussion of important subjects for further investigation focused on five broad, and often overlapping, content areas: epidemiology, research methodology, functional behaviors, efficacy of interventions, and safety. Barriers to conducting correctional research that the group identified included funding difficulties, resistance from stakeholders, restricted access to subjects, limited information technology, ethical concerns, and institutional review board (IRB) requirements. Potential strategies for overcoming these barriers, such as setting appropriate priorities, easing the burden of research protocols, identifying key collaborators, and facilitating the IRB-approval process, were also discussed.

Correctional health offers unparalleled opportunities for primary care research on clinical outcomes for a unique population and setting that provide rich experiences for health professions education, training, and practice. Because all correctional facilities are part of a larger community and 95% of inmates will eventually be released back to their communities, inmate health and well-being have a direct impact on the larger community. Collaborations between academic and correctional medicine can significantly affect the public’s health by providing care to one of its most vulnerable populations, one with significant pathology and health disparities.

To improve knowledge of and encourage testing for HIV, hepatitis, and sexually transmitted diseases among inmates, Albany Medical College and the New York State Department of Corrections developed a peer-led videotape and comic-book-style pamphlet. Inmates assigned to an intervention group viewed the videotape and pamphlet and completed pre- and posttest questionnaires; a control group did not. Both groups completed a risk assessment and testing request form. Analysis sought to detect testing request differences between groups and changes in disease knowledge among intervention group participants. Although more intervention participants requested testing, the differences were not statistically significant. After viewing the videotape, significantly more inmates agreed that communicable diseases are treatable (78.3%), that not all have symptoms (70.8%), and that a positive diagnosis is not a death sentence (82.5%). Videotapes and pamphlets can improve inmate knowledge, information retention, attitudes, and requests for communicable disease testing.

The growth of the prison system in recent years and its need for continuous operations have required correctional officers to adjust to night and shift work, which creates special demands on their health and performance. Working when he or she would otherwise be asleep, the officer’s biological clock can produce physiological, psychological, and behavioral changes that compromise attention, reaction time, risk taking, and efficiency, and that promote errors. By understanding the changes that shift work introduces, administrators, officers, and their families can be better prepared to cope with shift stress. Organizational, home, and personal shift-adjustment procedures are described and recommended.

The correctional system provides an opportunity to improve the functionality and quality of life of inmates who are mentally ill. Patients’ ability to tolerate medications influences their adherence to a medication regimen. Rates of nonadherence among bipolar patients are unacceptably high. In an effort to reduce treatment costs, many correctional programs are considering eliminating newer psychotropic medicines on their formularies in favor of cheaper generic medications. We retrospectively identified all patients incarcerated in the Muscogee County Jail who were treated with valproic acid, Depakote DR, or the recently available extended release form of divalproic sodium, Depakote ER. The purpose was to discover if patient compliance improved when switched from valproic acid or Depakote DR to the once-a-day dose of Depakote ER.