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This paper aims to describe the Recovering Citizenship Learning Collaborative (RCLC), a training, consultation and implementation effort for 13 local mental health authorities and two state hospitals.

The learning collaborative used a Recovering Citizenship approach, which holds that recovery occurs in the context of people’s lives in their communities and society, that is, their citizenship. The RCLC was implemented by the Connecticut Department of Mental Health and Addiction Services (DMHAS) in the USA and the Yale Program for Recovery and Community Health along with lived experience leaders. The RCLC supported system change through training DMHAS staff on concepts of recovery and citizenship and developing agency action plans, with the long-term goal of improving citizenship-oriented care at the agency-level and recovery and citizenship-related outcomes for people receiving services.

Lessons learned include the importance of assessing organizational readiness for change, addressing leadership investment and attention to systemic barrier, and offering tools to promote structure and accountability. Next steps are supporting agency action plans through technical assistance, state-wide educational offerings and a resource library.

Systemic barriers are considerable and must be addressed before system transformation is possible.

The authors are hopeful that the RCLC has been part of overcoming those challenges and can be a tool for building foundations for improving citizen practices and people’s citizenship-related outcomes.

Next steps are sustaining agency action plans, ongoing agency-specific technical assistance, ongoing state-wide educational offerings and a resource library.

The RCLC has provided tools and supports to build the foundation for improved citizenship practices and client outcomes at the multiagency system level.

This case was based on both primary and secondary data. In-depth semidirected interviews were conducted in 2021–2022 after receiving the institutional research board approval. The interviews took an approximate time ranging from 90 to 120 min. They were recorded and transcribed. A thematic analysis was undertaken to identify the most relevant themes for the case. The secondary sources used included various websites, scholarly and trade journals, as well as specific databases, such as Statista.

The case exposes students in multiple disciplines to the challenges created by the COVID-19 crisis at Yale School of Medicine (YSM). It describes its remarkable effects on organizational and community members as they struggled to reimagine more inclusive and supportive spaces. As one of the most severe crises humanity has ever witnessed, COVID-19 exacerbated the existing struggles of the underrepresented communities, creating a double pandemic. It has also amplified inequities among marginalized groups including black, indigenous and people of color; women; immigrants; lesbian, gay, bisexual, transgender, queer/questioning; people with different abilities; working parents; single parents; religious minorities; and people with low income. When COVID-19 hit in 2020, Yale University School of Medicine (YSM), like other pioneering schools in the field of health care, doubled their efforts to face both the public health crisis and the substantial social turmoil (racial tensions after the death of George Floyd, food insecurity, vaccine resistance, social inequalities, etc.). Professor Marietta Vazquez, MD, who was the first Latina to be named Associate Dean for Medical Students Diversity at YSM, launched with Dr Latimore (Chief Diversity Officer) and her other colleagues many strategic initiatives aiming at improving the diversity, equity and inclusion of organizational and community members.

The case is an invitation to graduate students and students in executive education programs to reflect on the grand challenges leaders faced at YSM as well as in other institutions across the nation and the globe. It is also a call to reimagine ways leaders can accelerate the pace of change in their organizational ecosystems.

This case was written for use in graduate-level courses, including executive education dealing with Diversity, Equity, Inclusion and Belonging, Leadership and Change, Health-Care Equity/Policy, Health Sciences, Human Resource Management, Organizational Behavior, Crisis Management, Sustainability, Business and Society, Social Issues in Management, Strategy, etc. Faculty members can easily adapt the case to fit the content of the course they teach, the students’ context as well as the specific learning outcomes to be achieved.

The purpose of this paper is to gain understanding about the effectiveness of a forensic peer support program’s impact on reducing criminal recidivism. People with histories of mental illness returning to the community following incarceration face tremendous challenges in jails and prisons and in successful reentry to community. Transitioning from jails and prisons is fraught with additional challenges such as reconnecting or connecting with mental health and substance abuse treatment, finding adequate housing, finding employment, reuniting with family and friends, etc. Unfortunately, recidivism remains high, principally because of these challenges. Many state and local authorities have supported the development of the forensic peer specialist.

Kaplan–Meier survival analyses were conducted to examine time to re-incarceration.

The population served was determined to be a particularly high risk of re-incarceration population, when released from prison. All had a mental illness diagnosis, with 80 percent diagnosed with at least one serious mental illness, and more than 50 percent had three or more anterior incarcerations. Utilizing Kaplan–Meyer survival analysis, the chance of re-incarceration for participants after one year was of 21.7 percent. Surprisingly, in the first year after release from prison, participants did much better than those in the general US prison population when in terms of re-incarceration rates (21.7 percent vs 43.4 percent).

While preliminary findings of this approach, this study reaffirms the idea that forensic peer support programs are beneficial in reducing recidivism rates for people diagnosed with a mental illness coming out of prison, offering individuals supports to maintain their lives in the community.

Incarcerated transgender women often require healthcare to meet their physical-, mental-, and gender transition-related health needs; however, their healthcare experiences in prisons and jails and interactions with correctional healthcare providers are understudied. The paper aims to discuss these issues.

In 2015, 20 transgender women who had been incarcerated in the USA within the past five years participated in semi-structured interviews about their healthcare experiences while incarcerated.

Participants described an institutional culture in which their feminine identity was not recognized and the ways in which institutional policies acted as a form of structural stigma that created and reinforced the gender binary and restricted access to healthcare. While some participants attributed healthcare barriers to providers’ transgender bias, others attributed barriers to providers’ limited knowledge or inexperience caring for transgender patients. Whether due to institutional (e.g. sex-segregated prisons, biased culture) or interpersonal factors (e.g. biased or inexperienced providers), insufficient access to physical-, mental-, and gender transition-related healthcare negatively impacted participants’ health while incarcerated.

Findings highlight the need for interventions that target multi-level barriers to care in order to improve incarcerated transgender women’s access to quality, gender-affirmative healthcare.

This study provides first-hand accounts of how multi-level forces serve to reinforce the gender binary and negatively impact the health of incarcerated transgender women. Findings also describe incarcerated transgender women’s acts of resistance against institutional and interpersonal efforts to maintain the gender binary and present participant-derived recommendations to improve access to gender affirmative healthcare for incarcerated transgender women.

Leadership training refers to the process of helping individuals develop skills to successfully perform in leadership positions. Existing leadership programs have several drawbacks, including the paucity of leadership programs designed for lesbian, gay, bisexual, transgender and queer (LGBTQ+) individuals in health care. The authors addressed this gap by creating and hosting Q-Forward (formerly Q-Med), the first conference focused specifically on leadership development for LGBTQ+ health trainees.

In this paper, the authors explain how a conference focused on leadership development for LGBTQ+ health trainees can have benefits for trainees, patients and the health-care system. The authors also report the conference proceedings, including planning, participants, guiding principles and programming.

This conference was the first conference for LGBTQ+ health trainees focused specifically on leadership training. The authors believe that the conference was unique, and that such training represents an essential step toward long-term improvements in the health of LGBTQ+ people and other populations.

People in prison are at a higher risk of preventable mortality from infectious disease such as human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis B (HBV), hepatitis C (HCV) and tuberculosis (TB) than those in the community. The extent of infectious disease-related mortality within the prison setting remains unclear. The purpose of this paper was to collate available information on infectious disease-related mortality, including the number of deaths and calculate the person-time death rate.

The authors searched databases between 1 January 2000 and 18 November 2020 for studies reporting HIV, HBV, HCV, TB and/or HIV/TB-related deaths among people in prison.

The authors identified 78 publications drawn from seven Joint United Nations Programme on HIV/AIDS’ regions encompassing 33 countries and reporting on 6,568 deaths in prison over a 20-year period. HIV/AIDS (n = 3,305) was associated with the highest number of deaths, followed by TB (n = 2,892), HCV (n = 189), HIV/TB (n = 173) and HBV (n = 9). Due to the limitations of the available published data, it was not possible to meta-analyse or in any other way synthesise the available evidence.

To inform targeted efforts to reduce mortality, there is a need for more, better quality data to understand infectious disease-related mortality in custodial settings. Increased investment in the prevention and management of infectious diseases in custodial settings, and in documenting infectious disease-related deaths in prison, is warranted and will yield public health benefits.

To the authors’ best knowledge, this is the first scoping review focussed on deaths due to these infections among people in prison internationally. The gaps identified form recommendations to improve the future collection and reporting of prison mortality data.

Little is known about the health status of prisoners in low-income countries. In Haiti, prisons typically lack adequate medical care, clean water and food, though some prisoners receive additional food from visitors. The purpose of this paper is to characterize the physical and mental health of Haitian prisoners in three select prisons and examine the effects of having visitors and length of detention on health status. The authors hypothesized that prisoners with more visitors and shorter detention times would have better overall health status.

The authors conducted a cross-sectional study of 290 male inmates in three regional prisons in Haiti. Data were collected on prisoners’ sociodemographic characteristics, number of visitors, length of detention, body mass index (BMI), self-reported physical and mental health status, and food insecurity.

Overall, prisoners at all three prisons had poor health outcomes. Prisoners with more visitors were significantly less likely to be underweight and more likely to have a higher BMI, better self-reported physical function and lower levels of food insecurity. The length of incarceration was negatively associated with physical function and self-rated health, but positively associated with BMI. These results suggest that prisoners who do not receive supplemental food from visitors are at increased risk for food insecurity and poor nutritional and physical health status.

These findings demonstrate the importance of supplemental food from visitors in stabilizing prisoner health in Haiti and emphasize the need for the provision of adequate nutrition to all prisoners. This study also suggests that policies that reduce incarceration times could improve health status among prisoners.

This paper aims to describe a performance improvement process related to suicide assessment in a community mental health center. As suicide rates rise in the USA, it is crucial that community mental health providers are capable and comfortable to assess for suicide risk among individuals with mental illness. Support for healthcare providers is emphasized in the quadruple aim model of enhancing healthcare delivery and patient experience. The quadruple aim model is applied in the present performance improvement project in a community mental health center.

An interprofessional team used provider survey responses, critical incident data and other stakeholder input to implement a new assessment mechanism and education plan to support direct care staff to address suicide risk.

Although the rate of patient death by suicide at the community mental health center is low, managing risk is a frequent provider concern. Providers’ comfort assessing and managing suicide risk varied widely based on survey responses. A structured suicide assessment process was implemented to offer clarity and direction for providers. Education to address assessment and management was designed and implemented.

Suicide data were retrospective and limited to known deaths, thus there may have been higher numbers of deaths by suicide historically. Providers’ comfort with suicide risk management was based on self-report and future work should also integrate skills-based assessment.

Improving the provider experience in mental health care must be explored. Focusing on provider input and voice in suicide-related efforts in community settings is a step toward integrating the quadruple aim ideals into mental health care.

With a rapidly growing population of older adults with chronic illness in US prisons, the number of people who die while incarcerated is increasing. Support for patients’ medical decision-making is a cornerstone of quality care for people at the end of life (EOL). This study aims to identify, describe, and analyze existing policies regarding EOL decision-making in U.S. Departments of Corrections.

This study performed an iterative content analysis on all available EOL decision-making policies in US state departments of corrections and the Federal Bureau of Prisons.

This study collected and reviewed available policies from 37 of 51 prison systems (73%). Some areas of commonality included the importance of establishing health-care proxies and how to transfer EOL decision documents, although policies differed in terms of which patients can complete advance care planning documents, and who can serve as their surrogate decision-makers.

Many prison systems have an opportunity to enhance their patient medical decision-making policies to bring them in line with community standard quality of care. In addition, this study was unable to locate policies regarding patient decision-making at the EOL in one quarter of US prison systems, suggesting there may be quality-of-care challenges around formalized approaches to documenting patient medical wishes in some of those prison systems.

To the best of the authors’ knowledge, this is the first content analysis of EOL decision-making policies in US prison systems.