The proposed study covers 5 years and includes 2 major research phases intended to reduce HIV and other addiction-related disease risks in criminal justice (CJ) populations. The first phase is a Disease Risk Reduction (DRR) intervention effectiveness study, and the second addresses its implementation in CJ field settings. A manual-guided DRR planning and decision-making strategy will be based on cognitive tools that focus on an evidence-based, visual-spatial (rather than traditional didactic) communication approach. It will focus on risky sexual and drug use behaviors during re-entry, including problem recognition, commitment to change, and strategies for avoiding behavioral risks of infections. Motivational and planning sessions will be delivered near the end of CJ institution-based substance abuse treatment, and they will also bridge into re- entry care services during community transitional treatment by using a series of self-study toolkits emphasizing applications of DRR principles. Offender-level engagement and functioning will be the key analytical focus of this initial study phase. In the second phase of the project, the process of intervention implementation will be examined in an expanded network of CJ systems in Texas as well as 3 adjoining states (Arizona, New Mexico, and Oklahoma). This phase will employ a naturalistic research design relying on organizational needs and functioning assessments (based on staff evaluations of DRR intervention training and utilization) in the analyses of implementation progress in institution and community-based re-entry divisions of the CJ system. When compared to "standard care" currently used during institution-based treatment, the DRR intervention is expected to significantly improve offender motivation, commitment, and self-confidence in planning their behavioral risk-reduction strategies for use during community re-entry. It also is expected that DRR re-entry self-study guides will further increase the rate of offender use of support networks in the community, reduce their risk levels related to drug use and sexual behaviors, and decrease their likelihood of re-incarceration during follow-up. More favorable offender psychosocial functioning and engagement during institution-based treatment likewise are expected to be positively associated with better outcomes during community re-entry. In the implementation evaluation study (Phase 2), institution and community-based re-entry teams (representing CJ systems across 4 states) are expected to respond to innovation training and make applications of DRR components commensurate with their collective perceptions about program needs, pressures, resources, and organizational fitness. That is, higher (average) ratings by staff members at CJ sites (e.g., in-prison treatment and probation/parole regions) of needs, readiness for HIV intervention services, organizational resources, mission, and operational climate are expected to predict greater participation and responsiveness to subsequent training for the DRR innovation. These indicators, in turn, are expected to predict higher DRR utilization and staff satisfaction at the post-training follow-up.
Effective HIV/AIDS-risk reduction interventions for criminal justice populations can offer significant public health benefits, both to offenders themselves and the public at large. However, there are challenges to "engaging" and convincing offenders with substance abuse histories to adequately plan and apply risk reduction principles during the crucial community re-entry phase after imprisonment. Correctional systems also are often fragmented, representing another challenge to efforts to provide integrated care and supervision to offenders at-risk for infectious diseases. The current proposal addresses both of these highly significant issues.
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