Sustained impacts of North Carolina prison therapeutic diversion units on behavioral outcomes, mental health, self-injury, and restrictive housing readmission

Remch, Molly; Mautz, Charles; Austin, Anna E.; Junker, Gary; Proescholdbell, Scott; Naumann, Rebecca B.

doi:10.1016/j.ypmed.2022.107318

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…In fact, individuals returning to the general prison population from RDU had a higher hazard of first violent infraction than their peers returning from RHCP. This sort of rebound effect has been observed after other restrictive housing diversion programs in NC prisons and suggests a potential need for sustained programming beyond the resource-intensive RDU diversion program and into the general prison population (Remch et al 2022 ). In addition, this highlights the need to consider the general prison environment and the contextual and situational factors that may contribute to violent behaviors in this environment, such as inconsistent application of rules and consequences for specific behaviors (McCorkle et al 1995 ; Mcguire 2018 ; Steiner et al 2014 ; Steiner and Wooldredge 2008 ).…”

Section: Discussionmentioning

confidence: 85%

“…Men who met these criteria at the time of RDU enrollment contributed 417,343 person-days to the RDU-exposed group. Men who met these criteria while placed in RHCP, and who had not been previously enrolled in RDU or another restrictive housing diversion program (i.e., Therapeutic Diversion Units (TDUs, which have also previously been evaluated)) (Remch et al 2021 , 2022 ), contributed 480,479 person-days to the RHCP-exposed group. Men who contributed person-days to the RHCP-exposed group and later enrolled in the RDU could contribute person-time to both groups.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of a prison violence prevention program: impacts on violent and non-violent prison infractions

Remch,

Swink,

Mautz

et al. 2023

Inj. Epidemiol.

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Background Individuals who commit acts of violence in prisons are often placed in highly controlled environments called restrictive housing (i.e., solitary confinement), which can have severe physical and mental health consequences and does not reduce violence. As such, North Carolina prisons have introduced the rehabilitative diversion unit (RDU) to reduce the use of restrictive housing and reduce violence in prison. Methods We evaluated the effect of the RDU on prison infractions. We compared rates of infractions by type (including violent infractions) among men enrolled in the RDU and men who were eligible for the RDU but placed in restrictive housing for control purposes (RHCP). We also evaluated sustained program impacts by comparing the hazard of first infraction among these same two groups of men after program completion, when they had returned to the general prison population. Finally, we compared the hazard of first promotion to a less restrictive custody level (medium custody) when these men had returned to the general prison population. Results The primary analytic cohort was made up of 3128 men contributing 897,822 person-days. Adjusted rates of violent infractions were lower in the RDU than in RHCP (adjusted rate ratio: 0.6; 95% CI: 0.4, 1.1). All other categories of infractions, including drug-related infractions, occurred at higher rates during RDU, as compared to RHCP. In analyses of sustained program impacts, for most categories of infractions, there were no differences in the hazard of first infraction post-RDU and post-RHCP. However, the hazard of violent infraction post-RDU was higher (adjusted hazard ratio: 2.1; 95% CI: 1.1, 4.0) than post-RHCP. The hazard of promotion to a less restrictive custody level was higher post-RDU (adjusted hazard ratio: 17.4; 95% CI: 7.2, 42.2) than post-RHCP. Conclusions We found the RDU program may be effective in reducing violence for men enrolled in the program, but that these benefits were not sustained. Continued programming may be a useful tool to transition men from the programmatically intensive environment of the RDU to the general prison population. Additionally, we recommend the expansion of evidence-based treatment for substance use disorder.

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Section: Discussionmentioning

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Evaluation of a prison violence prevention program: impacts on violent and non-violent prison infractions

Remch,

Swink,

Mautz

et al. 2023

Inj. Epidemiol.

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“…Still, because the implementation of more severe punishment did not reduce misconduct, the results may support the use of less-punitive approaches to dealing with institutional misbehavior, such as restricted movement within one's housing unit or other loss of privileges (see Browne et al, 2011) or therapeutic diversion units (see Remch et al, 2022). It is possible that employing alternatives to segregation for less serious offenses and reserving shorter segregation sentences for more serious offenses could avoid some of the harmful effects of segregation (e.g., Haney, 2003Haney, , 2012Haney, , 2018Haney & Lynch, 1997;Kupers, 2008;Luigi et al, 2020;Reiter et al, 2020;Shalev, 2009;Wildeman & Andersen, 2020) without sacrificing prison safety.…”

Section: Discussionmentioning

confidence: 96%

Did Changes to Disciplinary Segregation Policy Affect Rates of Institutional Misconduct?

McNeeley

2023

Criminal Justice and Behavior

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Due to concerns about the harmful effects of restrictive housing, the Minnesota Department of Corrections reduced the maximum disciplinary segregation sentence length from 720 days (about 2 years) to 90 days in September 2016. Then, in response to a perceived increase in violence within the facilities, the policy was changed again in July 2019 to allow for maximum segregation sentences of nearly a year for the most serious offenses. This study employs a quasi-experimental design to empirically test whether and how these changes affected total misconduct, violent misconduct, and incarcerated-person-on-staff assault within Minnesota prisons. The results of interrupted time series analyses showed a moderate, statistically significant initial increase in violent misconduct after the reduction in segregation sentence length in September 2016. There were also statistically significant and larger initial increases in both violent and total misconduct after the July 2019 increase in segregation sentence length for serious infractions.

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Suicide Mortality Among Formerly Incarcerated People Compared With the General Population in North Carolina, 2000–2020

Fitch,

Pence,

Rosen

et al. 2023

American Journal of Epidemiology

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We aimed to compare rates and characteristics of suicide mortality in formerly incarcerated people to the general population in North Carolina (NC). We conducted a retrospective cohort study of 266,400 people released from NC state prisons between January 1, 2000 and March 1, 2020. Using direct and indirect standardization by age, sex, and calendar year, we calculated standardized suicide mortality rates and standardized mortality ratios comparing formerly incarcerated people to the NC general population. We evaluated effect modification by race-ethnicity, sex, age, and firearm involvement. Formerly incarcerated people had approximately twice the overall suicide mortality of the general population for three years after release, with the highest rate of suicide mortality being in the two-week period after release. In contrast to patterns in the general population, formerly incarcerated people had higher non-firearm-involved suicide mortality rates than firearm-involved suicide mortality rates. Formerly incarcerated female, White and Hispanic/Latino, and emerging adult people had greater elevation of suicide mortality compared to their general population peers than did other groups. These findings suggest a need for long-term support for formerly incarcerated people as they return to community living and identify opportunities for interventions that reduce the harms of incarceration for especially vulnerable groups.

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Sustained impacts of North Carolina prison therapeutic diversion units on behavioral outcomes, mental health, self-injury, and restrictive housing readmission

Cited by 3 publications

References 21 publications

Evaluation of a prison violence prevention program: impacts on violent and non-violent prison infractions

Evaluation of a prison violence prevention program: impacts on violent and non-violent prison infractions

Did Changes to Disciplinary Segregation Policy Affect Rates of Institutional Misconduct?

Suicide Mortality Among Formerly Incarcerated People Compared With the General Population in North Carolina, 2000–2020

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