Edwards Layla, Jamieson Sacha Kendall, Bowman Julia, Chang Sungwon, Newton Josie, Sullivan Elizabeth
School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, 2007, Australia.
Sydney School of Education and Social Work, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, NSW, 2006, Australia.
Health Justice. 2022 Jan 3;10(1):1. doi: 10.1186/s40352-021-00162-6.
The rising rates of women in prison is a serious public health issue. Unlike men, women in prison are characterised by significant histories of trauma, poor mental health, and high rates of substance use disorders (SUDs). Recidivism rates of women have also increased exponentially in the last decade, with substance related offences being the most imprisoned offence worldwide. There is a lack of evidence of the effectiveness of post-release programs for women. The aim of this systematic review is to synthesise and evaluate the evidence on post-release programs for women exiting prison with SUDs.
We searched eight scientific databases for empirical original research published in English with no date limitation. Studies with an objective to reduce recidivism for adult women (⩾18 years) with a SUD were included. Study quality was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB2) and the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tools.
Of the 1493 articles, twelve (n = 3799 women) met the inclusion criteria. Recidivism was significantly reduced in five (42%) programs and substance-use was significantly reduced in one (8.3%) program. Common attributes among programs that reduced recidivism were: transitional, gender-responsive programs; provision of individualised support; providing substance-related therapy, mental health and trauma treatment services. Methodological and reporting biases were common, which impacted our ability to synthesize results further. Recidivism was inconsistently measured across studies further impacting the ability to compare results across studies.
Recidivism is a problematic measure of program efficacy because it is inconsistently measured and deficit-focused, unrecognising of women's gains in the post-release period despite lack of tailored programs and significant health and social disadvantages. The current evidence suggests that women benefit from continuity of care from prison to the community, which incorporated gender-responsive programming and individualised case management that targeted co-morbid mental health and SUDs. Future program design should incorporate these attributes of successful programs identified in this review to better address the unique challenges that women with SUDs face when they transition back into the community.
女性入狱率上升是一个严重的公共卫生问题。与男性不同，入狱女性的特点是有大量创伤史、心理健康状况不佳以及物质使用障碍（SUDs）发生率高。在过去十年中，女性的累犯率也呈指数级增长，与物质相关的犯罪是全球范围内入狱率最高的犯罪类型。缺乏关于出狱后项目对女性有效性的证据。本系统评价的目的是综合和评估关于患有SUDs的出狱女性的出狱后项目的证据。
我们在八个科学数据库中搜索了不限日期的以英文发表的实证性原创研究。纳入旨在降低成年女性（≥18岁）SUDs累犯率的研究。使用修订后的Cochrane随机试验偏倚风险工具（RoB2）和非随机干预研究中的偏倚风险（ROBINS-I）工具评估研究质量。
在1493篇文章中，有12篇（n = 3799名女性）符合纳入标准。五个（42%）项目的累犯率显著降低，一个（8.3%）项目的物质使用显著减少。降低累犯率的项目的共同属性包括：过渡性、对性别有响应的项目；提供个性化支持；提供与物质相关的治疗、心理健康和创伤治疗服务。方法学和报告偏倚很常见，这影响了我们进一步综合结果的能力。各研究中对累犯率的测量不一致，进一步影响了跨研究比较结果的能力。
累犯率是项目疗效的一个有问题的衡量标准，因为它的测量不一致且以缺陷为重点，尽管缺乏量身定制的项目以及存在重大的健康和社会劣势，但却没有认识到女性在出狱后阶段的收获。目前的证据表明，女性受益于从监狱到社区的连续性护理服务，其中包括对性别有响应的规划和针对合并心理健康问题和SUDs的个性化病例管理。未来的项目设计应纳入本评价中确定的成功项目的这些属性，以更好地应对患有SUDs的女性重返社区时面临的独特挑战。
