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Incorporating an Afrocentric Approach into the Criminal Justice System: The Voices of Men Who Attend the Habilitation Empowerment Accountability Therapy (HEAT) Program
Objective: The purpose of this study was to estimate the behavioral impacts of training police officers in implicit bias awareness and management. Hypotheses: Training police in implicit bias reduces racial and ethnic disparities in stops, arrests, summonses, frisks, searches, and/or use of force. Method: A cluster randomized controlled trial using the stepped wedge design was applied to 14,471 officers in the New York City Police Department, with a 1-day training delivered to clusters of police commands between May 2018 and April 2019 and outcomes measured with police records of individual events from April 2018 to May 2019. Police records were supplemented with survey data on 1,973 officers matched to administrative data. For each type of enforcement action, the likelihood that the action involved or was taken against Black or Hispanic suspects, respectively, relative to White suspects was estimated, controlling for potential confounders. Additional analysis allowed for estimating training effects of different magnitudes for Black, Hispanic, and White officers and for officers with greater motivation to act without prejudice or greater concern about discrimination. Results: None of the estimated training effects achieved statistical significance at the .05 level. Conclusions: Isolated and weak evidence of behavioral impacts of the training was detected. Several explanations for the null findings are considered.
Measurement of Afrocentrism and investigation of Afrocentricity’s significance in the lives of Black Americans has gained momentum, given the current evidence suggesting that cultural factors matter in the lives of diverse populations. In particular, factors associated with African philosophical constructs may have significant relationships with improved mental health and overall well-being among African and African diaspora populations. However, the prior conceptual literature suggests that Afrocentrism is a heterogenous concept with a multitude of domains associated with its measurement. The present study was envisioned given the relative absence of studies evaluating the availability and psychometric properties of Afrocentric measures within social work. Utilizing systematic analysis methodology and PRISMA guidelines, a search for Afrocentric measures was undertaken using four key databases. Spanning the literature between 1980 and 2021, this review identified a total of seven instruments that fully met the study’s inclusion-specific criteria. In accordance with the call for continued research and practice emphasizing resilience and protective factors within the lives of Black populations, the present study provides accessible knowledge to researchers and practitioners on the currently available instruments to evaluate Afrocentrism in the lives of populations of African descent.
We present the reflections of three clinical practitioners on ethical considerations when caring for individuals experiencing incarceration needing in-patient hospital services. We examine the challenges and critical importance of adhering to core principles of medical ethics in such settings. These principles encompass access to a physician, equivalence of care, patient’s consent and confidentiality, preventive healthcare, humanitarian assistance, professional independence, and professional competence. We strongly believe that detained persons have a right to access healthcare services that are equivalent to those available in the general population, including in-patient services. All the other established standards to uphold the health and dignity of people experiencing incarceration should also apply to in-patient care, whether this takes place outside or inside the prison boundaries. Our reflection focuses on the principles of confidentiality, professional independence, and equivalence of care. We argue that the respect for these three principles, although they present specific implementation challenges, is foundational for implementing the other principles. Critically important are respect for the distinct roles and responsibilities of healthcare and security staff as well as transparent and non-hierarchical dialogue between them to ensure optimal health outcomes and functioning of hospital wards while balancing the ongoing tensions between care and control.
Background
Community-based culturally tailored education (CBCTE) programs for chronic diseases may reduce health disparities; however, a synthesis across chronic diseases is lacking. We explored (1) the characteristics and outcomes of CBCTE programs and (2) which strategies for culturally appropriate interventions have been used in CBCTE programs, and how they have been implemented.
Methods
A systematic review was conducted by searching three databases to identify empirical full-text literature on CBCTE programs for Black communities with cardiovascular disease, hypertension, diabetes, or stroke. Studies were screened in duplicate, then data regarding study characteristics, participants, intervention, and outcomes were extracted and analyzed. Cultural tailoring strategies within programs were categorized using Kreuter and colleagues’ framework.
Results
Of the 74 studies, most were conducted in the USA (97%) and delivered in one site (53%; e.g., church/home). CBCTE programs targeted diabetes (65%), hypertension (30%), diabetes and hypertension (1%), cardiovascular disease (3%), and stroke (1%). Reported program benefits included physiological, medication-related, physical activity, and literacy. Cultural tailoring strategies included peripheral (targeted Black communities), constituent-involving (e.g., community informed), evidential (e.g., integrated community resources), linguistic (e.g., delivered in community’s dialect/accent), and sociocultural (e.g., integrated community members’ religious practices).
Conclusions
CBCTE programs may have beneficial outcomes, but a small sample size limited several. The strategies identified can be adopted by programs seeking to culturally tailor. Future interventions should clearly describe community members’ roles/involvement and deliver programs in multiple locations to broaden reach.
Trial Registration
PROSPERO CRD42021245772.
Stereotypes are ingrained in the fabric of the USA and coincide with the institution of slavery. The expected behaviors of African-Americans are fueled by stereotypes maintained by the status quo. Throughout US history, the stereotyping of African-Americans, particularly males, has had a negative impact on African-American families and communities. For instance, the belief that African-Americans are unintelligent, lazy, violent, and criminals has affected educational outcomes, employment opportunities, socioeconomic status, and the dismantling of African-American families and communities. Educators, businessmen, and law enforcement often believe these stereotypes, which influences their treatment of African-Americans. The oppression of African-Americans is a critical human rights issue that has to be addressed in social work practice. This article highlights a historical overview of how stereotypes have contributed to a denial of human rights, evidenced by inequalities in education, employment, and the justice system. Recommendations for culturally competent interventions and practice to improve social equity are discussed.
Purpose of Review
We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions.
Recent Findings
There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health.
Summary
There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.
Drug courts have been used in the criminal justice system to treat substance use disorders since 1989. This study evaluates a drug court in Indiana, focusing specifically on the most predictive variables for being terminated from the program and comparing recidivism patterns of drug court and probation participants. Participants were most likely to be terminated from drug court if they did not have a high school diploma or equivalent at admission, were not employed or a student at admission, identified cocaine as a drug of choice, had more positive drug tests, had a violation within the first 30 days of the program, and had a criminal history. Additional findings suggest that drug court is more effective than probation at reducing criminal recidivism rates for offenders with substance use disorders. Implications for drug court practice and future research are discussed.
There has been a rapid proliferation of drug courts over the past two decades. Empirical research examining the effectiveness of the model has generally demonstrated reduced rates of recidivism among program participants. However, relatively little is known about the structure and processes associated with effective drug courts. The current study seeks to address the issues by exploring the moderating influence of programmatic and non-programmatic characteristics on effectiveness. The methodology goes beyond previous meta-analyses by supplementing published (and unpublished) findings with a survey of drug court administrators. Consistent with previous research, the results revealed drug courts reduce recidivism by 9% on average. Further analyses indicated target population, program leverage and intensity, and staff characteristics explain the most variability in drug court effectiveness. These findings are discussed within the context of therapeutic jurisprudence and effective interventions.
Drug courts are often the last chance for criminal justice-involved persons with substance use disorders to avoid incarceration. Given this stark reality, participation in drug court should not be influenced by race. This study tracks cohorts of drug court referrals to compare referral, admission, and graduation rates by race in two states and eight counties in diverse regions of the United States. We compared admission and graduation rates by race in each state or county using tests of the difference between independent proportions, displayed graphically with longitudinal state-level data. Black persons had lower referral and admission rates in nearly all jurisdictions for which requisite data were available, and lower graduation rates in six of the ten jurisdictions. In statewide analyses for which adequate longitudinal data were available, racial differences in admission and graduation rates persisted for up to a decade. Practice and policy recommendations are offered to improve measurement of cultural disparities in drug courts and the broader justice system and implement remedial strategies.
Treatment courts have been part of the criminal justice system for nearly three-and-a-half decades. The first treatment court, an adult drug court, began in 1989 in Florida, and due to the success of drug courts in reducing criminal recidivism rates, the intervention has evolved to address other problems and populations, such as veterans treatment courts (VTCs) and family treatment courts (FTCs). Treatment courts have been credited with promoting criminal justice reform, as they offer a rehabilitative approach to justice, as compared to historical punitive models. Research, however, has consistently shown that racial and ethnic minorities have lower completion rates in some treatment courts than their white counterparts. This study is the first statewide evaluation to use the Racial and Ethnic Disparities (RED) Program Assessment Tool to assess for racial and ethnic disparities in programming across several types of treatment courts (n = 30). Results showed that 64.9% of white participants completed treatment court, whereas all other races had completion rates less than 30.0%. Implications for treatment court practice are discussed in reference to staff training, the quality of treatment participants receive for substance use and mental health disorders, future research, and other key components of the treatment court model.
Objective:
As rates of non-completion in substance use treatment remain high and consequences of non-completion can be severe, research regarding individual and environmental factors associated with specific types of discharge is critical. The current study utilized data from the Treatment Episodes Dataset - Discharge (TEDS-D) 2015-2017 in the United States to investigate the impact of social determinants of health on discharge from treatment due to termination by the treatment facility in both outpatient/IOP and residential treatment settings.
Method:
A multinomial logistic regression was conducted examining the likelihood of discharge due to termination compared to discharge due to 1) drop-out, or 2) incarceration.
Results:
Results revealed differences in termination based on treatment setting, race, income, criminal justice referral, and mental health diagnoses among others. Broadly across settings, People of Color were significantly more likely to be terminated from treatment than to drop out compared to their White counterparts. Further, with little exception, individuals with less financial security (i.e. being unemployed, having low/no income, no insurance) were less likely to drop out and more likely to be discharged due to termination across treatment settings.
Conclusions:
The results of the current study further solidify the need for nuanced examination of the reason individuals do not complete substance use treatment and extend the impact of social determinants of health to involuntary termination from substance use treatment.
It is well documented that people of color face disparities in access to and quality of healthcare. There are inequities in healthcare outcomes as well. The biases of healthcare providers are one of the many factors that contribute to healthcare incongruence. Often overlooked, race impacts therapeutic relationships and highlights ingrained patterns of binary thinking, thereby creating hierarchies. Some physicians experience anxiety regarding addressing racism, leading to avoidance of its existence and effects on the physician-patient alliance. Others address the dynamics by bringing the patient's family experiences and lived experience "in the room." By following the "emotional red thread," we can bring clarity to the issue of making racism a neutral topic of conversation in treatment. As it has so often in the past, racism should not and cannot be ignored.
Introduction
Experiences of racial discrimination in the medical setting are common among Black patients and may be linked to mistrust in medical recommendations and poorer clinical outcomes. However, little is known about the prevalence of experiences of racial mistreatment by healthcare workers among Black patients seeking addiction treatment, or how these experiences might influence Black patients' medical mistrust or expectations of care.
Methods
Participants were 143 Black adults recruited consecutively from two university addiction treatment facilities in Columbus, Ohio. All participants completed validated surveys assessing perceptions of prior racial discrimination in the medical setting and group-based medical mistrust. Participants were also asked a series of questions about their expectations of care with regard to racial discrimination and addiction treatment. Descriptive analyses were used to characterize the sample with regard to demographics, perceived racial discrimination and medical mistrust. Kendall tau-b correlations assessed relationships between racial discrimination, mistrust and expectations of care.
Results
Seventy-nine percent (n = 113) of participants reported prior experiences of racial discrimination during healthcare. Racial discrimination in the medical setting was associated with greater mistrust in the medical system and worse expectations regarding racial discrimination in addiction treatment including delays in care-seeking due to concern for discrimination, projected non-adherence and fears of discrimination-precipitated relapse.
Conclusions
Black patients seeking addiction treatment commonly report experiencing racial discrimination by healthcare workers which may be associated with mistrust in the medical system and expectations of care. Strategies to eliminate and mitigate experiences of racial discrimination may improve addiction treatment receptivity and engagement.
This review synthesizes the historical literature on the criminalization and incarceration of black Americans for an interdisciplinary audience. Drawing on key insights from new histories in the field of American carceral studies, we trace the multifaceted ways in which policymakers and officials at all levels of government have used criminal law, policing, and imprisonment as proxies for exerting social control in predominantly black communities from the colonial era to the present. By underscoring this antiblack punitive tradition in America as central to the development of crime-control strategies and mass incarceration, our review lends vital historical context to ongoing discussions, research, and experimentation within criminology and other fields concerned about the long-standing implications of institutional racism, violence, and inequity entrenched in the administration of criminal justice in the United States from the top down and the ground up.
Expected final online publication date for the Annual Review of Criminology, Volume 4 is January 13, 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
This study examined the acceptability and effectiveness of The Seven Challenges®, a comprehensive substance use counseling program focused on decision making, compared with commonly provided, or “standard,” cognitive-behavioral substance use treatment implemented with a focus on abstinence. Results, based on data from 71 adult drug court clients, indicated higher acceptability of The Seven Challenges than standard cognitive-behavioral treatment as reflected in treatment satisfaction, honesty, and disclosure, as well as perceived impact of treatment. Results also showed that The Seven Challenges was as effective as standard cognitive-behavioral treatment at improving vocational engagement and was more effective at reducing substance use, related problems, and internal mental distress. The Seven Challenges was also effective at reducing criminal activity, whereas clients of the standard cognitive-behavioral treatment appeared to increase criminal activity. These findings strengthen the existing evidence base of The Seven Challenges as a comprehensive counseling program addressing substance use, mental health problems, and criminality.
For nearly three decades, drug courts have provided a rehabilitative approach within the criminal justice system for individuals who have a substance use disorder. The goal of drug courts is to reduce criminal recidivism, and research has consistently suggested that participants that graduate drug court are less likely to recidivate than those who are terminated from the program. This qualitative study adds to the literature by asking drug court participants (N = 42) their views on the most helpful aspects of the program that support them in graduating and how the program could be more helpful to support them in graduating. Two themes emerged from the data: (1) participants felt that interventions that are common to drug courts, such as drug testing and having frequent contact with the judge, were most helpful in supporting them in graduating the program; (2) participants felt that the agencies that offered treatment for their substance use disorders used punitive tactics and judgmental approaches that compromised the quality of treatment they received, and they felt that this was a barrier to them graduating the program. The findings are discussed in reference to drug court practice.
The relationship between the Black community and law enforcement has received increased attention in the media in the last 3 years. Much of the conversation has centered around Black males and females being killed by police officers and the negative relationship between law enforcement and Black communities. This article focuses on how Afrocentricity can be applied to community policing as an option to address these issues. While much has been stated about community policing, nothing has been discussed that grounds the experience and the response in an African-centered perspective. By centering the discussion from a cultural perspective, African-centered theory can be utilized to frame the response within the Black experience and not from a Eurocentric perspective. Principles of the African-centered paradigm are identified and discussed as applied to creating a newly envisioned community policing initiative. Recommendations for the role of social workers are also offered with regards to having social workers interface with the criminal justice system from an African-centered perspective.
Drug courts are designed to offer treatment in lieu of incarceration for nonviolent offenders who have substance use disorders. Recent evidence has suggested the African American participants are less likely to graduate drug court than their white counterparts. This qualitative study interviewed 38 participants from a Midwestern drug court to compare and contrast white (n = 22) and African Americans (n = 16) lived experiences in the program in order to learn about the factors that may contribute to racial disparities in outcomes. Findings suggest that both white and African American participants felt that the drug court team was supportive and compassionate, and wanted them to succeed in the program. White participants found managing the demands of drug court with other obligations they had to be a noticeable challenge, and they also reported continued alcohol use in the program even though the program required total abstinence. African Americans were most critical about the quality of substance abuse treatment they received and felt that they were forced to accept culturally incompetent labels. Findings have implications for drug court practice and future research.
This book seeks to analyze the issue of race in America after the election of Barack Obama. For the author, the U.S. criminal justice system functions can act as a contemporary system of racial control, even as it adheres to the principle of color blindness.
This qualitative study with 14 African American participants of a Texas drug court explored the factors that might contribute to racial disparities in drug court outcomes. The findings suggest that the factors that might contribute to racial disparities in outcomes include African American participants’ (a) beliefs that drug court sanctions were not implemented in a culturally sensitive manner; (b) dissatisfaction with being mandated to attend Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) meetings; (c) perceptions that they were not offered enough resources to gain and maintain employment; (d) views that they were not receiving individualized treatment; and (e) beliefs that they can relate better to other African American clients and staff members. Implications for policy advocacy, future research, and social work practice are discussed.
PurposeThe objective of this research was to systematically review quasi-experimental and experimental evaluations of the effectiveness of drug courts in reducing offending.Methods
Our search identified 154 independent evaluations: 92 evaluations of adult drug courts, 34 of juvenile drug courts, and 28 of DWI drug courts. The findings of these studies were synthesized using meta-analysis.ResultsThe vast majority of adult drug court evaluations, even the most rigorous evaluations, find that participants have lower recidivism than non-participants. The average effect of participation is analogous to a drop in recidivism from 50% to 38%; and, these effects last up to three years. Evaluations of DWI drug courts find effects similar in magnitude to those of adult drug courts, but the most rigorous evaluations do not uniformly find reductions in recidivism. Juvenile drug courts have substantially smaller effects on recidivism. Larger reductions in recidivism were found in adult drug courts that had high graduation rates, and those that accepted only non-violent offenders.Conclusions
These findings support the effectiveness of adult drug courts in reducing recidivism. The evidence assessing DWI courts' effectiveness is very promising but more experimental evaluations are needed. Juvenile drug courts typically produce small reductions in recidivism.
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Developing a culturally proficient intervention for young African American men in drug court: Examining feasibility and estimating an effect size for habilitation empowerment accountability therapy (HEAT)
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