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OBJECTIVES

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  • Explore the causes and scope of global mass incarceration.

  • Identify socioeconomic and health disparities in individuals with criminal justice involvement.

  • Recognize the impact of criminal justice system involvement on health outcomes and care delivery.

  • Develop skills to prevent incarceration and mitigate effects of criminal justice system involvement on patients and families.

  • Appraise evidence-based interventions to improve health outcomes and reduce recidivism in individuals with a history of incarceration.

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Mr. Clark, a 54-year-old man who was released from prison 3 weeks ago, has visited the emergency department several times for suicidal ideation and atypical chest pain. He is also homeless.

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INTRODUCTION

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In the United States, 1 in 35 adults have been incarcerated and 1 in 43 children have a parent who is currently in prison—each year, more than 650,000 people are released from prisons and more than 7 million individuals are released from jails in the United States. Consequently, as a health-care provider, you are more likely to care for a patient who has been incarcerated or a patient whose parent has a history of involvement with the criminal justice system than you are to care for a patient who has sickle cell disease, cystic fibrosis, or type 1 diabetes (Box 27-1). Yet, health-care providers receive little training about this vulnerable population. Individuals who have been incarcerated disproportionately suffer from chronic illness, live in poverty, and face social marginalization—all of which are risk factors for and result from incarceration. The consequences of incarceration reverberate into patients’ families and neighborhoods, impacting community health and well-being.

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This chapter highlights the global prevalence of incarceration and the demographics and health disparities of individuals with a history of incarceration. Additionally, it discusses how criminal justice system involvement can confer vulnerability to an already at-risk population through inadequate medical care and suboptimal living conditions in prisons, barriers to health-care access upon release, and the collateral consequences arising from marginalization of those with a criminal record. Finally, it presents evidence-based interventions to reduce the health impacts of incarceration, and decreases risk of recidivism upon release.

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Box 27-1. Criminal Justice Terms

  • Jails: local correctional facilities that detain individuals awaiting trial or those sentenced to less than 1 year, increasingly, some states allow longer sentences.

  • Prisons: federal or state correctional facilities that detain individuals found guilty of felony crimes and those who have sentences longer than 1 year.

  • Parole allows a convicted individual to serve the remainder of a prison sentence in the community, often under supervised release.

  • Probation is a period either immediately post-release from jail or in lieu of detention, when an individual is supervised in the community by a criminal justice officer and faces greater penalties for criminal activities.

Collectively these terms describe involvement in the criminal justice system. Outside of the United States, the terms prison and jail are used interchangeably to describe correctional settings.

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