Recidivism, health and social functioning following release to the community of NSW prisoners with problematic drug use: study protocol of the population-based retrospective cohort study on the evaluation of the Connections Program

Abstract

IntroductionThe rising rate of incarceration in Australia, driven by high reoffending, is a major public health problem. Problematic drug use is associated with increasing rates of reoffending and return to custody of individuals. Throughcare provides support to individuals during imprisonment through to post-release, improving both the transition to community and health outcomes post-incarceration. The aim of this study is to evaluate the Connections Programme (CP) that utilises a throughcare approach for release planning of people in prison with a history of problematic drug use. The study protocol is described.Methods and analysisPopulation-based retrospective cohort study. The study will use record linkage of the Connections dataset with 10 other New South Wales (NSW) population datasets on offending, health service utilisation, opioid substitution therapy, pregnancy, birth and mortality. The study includes all patients who were eligible to participate in the CP between January 2008 and December 2015 stratified by patients who were offered CP and eligible patients who were not offered the programme (non-CP (NCP)). Propensity-score matching will be used to appropriately adjust for the observable differences between CP and NCP. The differences between two groups will be examined using appropriate univariate and multivariate analyses. A generalised estimating equation approach, which can deal with repeat outcomes for individuals will be used to examine recidivism, mortality and other health outcomes, including perinatal and infant outcomes. Survival analysis techniques will be used to examine the effect of the CP by sex and Indigenous status on the ‘time-to’ health-related outcomes after adjusting for potential confounders.Ethics and disseminationEthical approval was received from the NSW Population and Health Services Research Ethics Committee, the Justice Health and Forensic Mental Health Network Human Research Ethics Committee, the Aboriginal Health and Medical Research Council Ethics Committee, the Corrective Services NSW Ethics Committee and the University of Technology Sydney Human Research Ethics Committee.

Continuum of hepatitis C care cascade in prison and following release in the direct-acting antivirals era

“…However, the transition period is accompanied by many competing priorities that often prevent patients from ongoing engagement with care [ 9 , 11 ]. Such priorities include inadequate social and financial support, which often result in a return to drug-related activities and may erode all health benefits gained during incarceration [ 9 , 14 , 15 ].…”

Modeling the population‐level impact of opioid agonist treatment on mortality among people accessing treatment between 2001 and 2020 in New South Wales, Australia

“…Indeed, OAT provision in prison has been shown to be highly effective at reducing fatal overdose post‐release [ 6 ] and should be made available in correctional settings where it currently is not [ 71 ]. In addition, providing support during the month preceding release through engagement with recovery mentors and connection with community OAT services [ 72 ] has proved successful in facilitating treatment continuity, and findings from the impact evaluation of the ‘Connections’ program in NSW prisons on reducing mortality, recidivism and improving parenting outcomes will shed further light on these interventions [ 73 ]. OEND in correctional settings has been shown to be acceptable and feasible and to increase trainees’ self‐efficacy to respond to an overdose [ 74 ].…”

Developing best practice principles for the provision of programs and services to people transitioning from custody to the community: study protocol for a modified Delphi consensus exercise

“…People transitioning to the community after any period of incarceration are confronted with a range of challenges that may include health issues, barriers to accessing health services, issues in securing housing, lack of skills necessary to gain employment and loss of family connections 1 10–12. In addition, social disadvantage, and complex needs such as comorbid substance-use disorders and mental illness, acquired brain injury, homelessness and unemployment can exacerbate these challenges 7 11 13. Therefore, people exiting correctional facilities require substantial physical, psychological, social and economic support to transition into the community and avoid returning to custody 6 7 11 14–16…”

“…In addition, social disadvantage, and complex needs such as comorbid substance-use disorders and mental illness, acquired brain injury, homelessness and unemployment can exacerbate these challenges 7 11 13. Therefore, people exiting correctional facilities require substantial physical, psychological, social and economic support to transition into the community and avoid returning to custody 6 7 11 14–16…”