Sustainable Disease Risk Reduction Strategies for CJ Systems (DRR-2)

Well established and consistent use of HIV/HBV/HCV risk reduction prevention/intervention programs with continuity of care do not exist in most criminal justice treatment systems because of lack of policy development and integration between TEXT Box--DRR-2 Proj Infoinstitution and community-based corrections, health, and social service agencies. Risk reduction interventions targeting re-entry are crucial because of the likelihood for risk behaviors to increase upon return to the community. Risk reduction approaches for community corrections populations are needed that have the capability of addressing motivational, social, and cognitive deficits.

The first phase of this continuation project (DRR-1) developed and tested an in-prison, highly interactive group-based curriculum, titled WaySafe, that was designed to help offenders make better decisions regarding health risk behaviors after release back to the community. The current project is adapting the innovative WaySafe intervention for use with community-corrections populations. The adapted intervention, StaySafe, included twelve 10 minute self-administered sessions based on evidence-based cognitive principles designed to improve decision-making skills regarding health risk behaviors during the critical first several months under community supervision.

StaySafe has been administered to probationers in community corrections and residential substance abuse treatment settings. It utilizes tablet computers that provide an easy to use and interactive interface for probationers to work through an evidence-based, decision-making schema. An advantage of this approach is that it can be administered to probationers with minimal time commitment by staff and that it can utilize probationer down time when they are in between or waiting for appointments. This intervention has been implemented in the probation departments of several large counties in Texas after providing TCU IRB approved Informed Consent, and completing a baseline survey, volunteer probationers have been randomly assigned to an experimental (Stay Safe) or control (standard procedure; SP) arm.  Participants in the StaySafe arm were asked to complete 12 brief weekly StaySafe sessions and then a post-intervention survey at 3-months after baseline and a sustainability survey 6 months after baseline. Participants in the SP arm were asked to complete the 3- and 6- month surveys.

A total of 163 community corrections participants completed baseline surveys (82 were randomly assigned to StaySafe; 81 to SP) and 78 completed post-intervention surveys (40 StaySafe and 38 SP). In the residential settings, 351 completed baseline surveys (180 StaySafe and 171 SP) and 234 completed post-intervention surveys (119 StaySafe and 115 SP).  Not unexpectedly, attrition was higher in the community samples than in the residential samples.  Participants in the community completed StaySafe sessions and surveys when they came to the probation offices for meetings with probation officers or counselors or for group sessions.  Reasons for attrition included participant schedules changing so that they were no longer available to participate in the study, transferring to other probation office locations, absconding from probation, or getting re-arrested or simply dropping out of the study. In addition, scheduling subsequent and sending reminders generally involved phone or text messages and phone numbers often changed so that contact was lost with the participant.  Nevertheless, in spite of these difficulties, almost two-thirds of community StaySafe participants completed at least 6 StaySafe sessions and more than one-fourth completed all 12 sessions.  Participants who completed more sessions were more likely to be older, married and have had previous alcohol treatment (Lehman et al, 2018).

Participants in the residential settings had much lower attrition to the post-intervention survey and higher StaySafe participation rates.  These participants were typically at the residential settings for six months so were generally readily available for surveys and sessions.  Attrition in this sample was primarily a result of participants absconding from the residential setting.  A total of 88% of Residential participants in the StaySafe arm completed at least 6 StaySafe sessions and more than half completed all 12 sessions.

Overall, participants who completed StaySafe sessions, compared to those in Standard Practice, reported better decision-making skills, more knowledge about HIV, greater knowledge and motivation for avoiding risky sex and around risk reduction skills, and more knowledge about HIV test planning.  Participants who completed more StaySafe sessions tended to show more positive changed in knowledge and confidence around HIV and risk reduction skills. Qualitative interviews with a subset of StaySafe participants supported the efficacy of StaySafe to facilitate self-regulation skill development using the WORK-IT schema, raise self-awareness about HIV health risks and need for HIV testing, and dispel myths about HIV by delivering current and sometimes completely new information (e.g., PrEP medication; Pankow et al., 2018).

Selected Publications

Joe, G. W., Lehman, W. E. K., Rowan, G. A., Knight, K., & Flynn, P. M. (in press). Evaluating the impact of a targeted brief HIV intervention on multiple inter-related HIV risk factors of knowledge and attitudes among incarcerated drug users. Journal of HIV/AIDS & Social Services.

Lehman, W. E. K., Pankow, J., Rowan, G. A., Gray, J., Blue, T. R., Muiruri, R., & Knight, K. (2018). StaySafe: A self-administered android tablet application for helping individuals on probation make better decisions pertaining to health risk behaviors. Contemporary Clinical Trials Communications, 10, 86-93. PMCID: PMC6047315

Blue, T., Pankow, J., Rowan, G., & Lehman, W. (2017). Staying safe in the community: A table computer app for improving decision making and reducing health risk behaviors for probationers. Texas Probation, V(2), 11-17.

Lehman, W. E. K., Pankow, J., Blue, T. R., & Rowan, G. A. (2016, March/April). StaySafe: A tablet computer app for helping probationers make better decisions regarding health risk behaviors. Offender Programs Report, 19(6), 81, 90-95.

Selected Presentations

Lehman, W. E. K., Pankow, J., Joe, G. W., Muiruri, R., Knight, K., & Flynn, P. M. (2018, October).  Mixed method outcomes of StaySafe, a computer tablet app to improve decision making around health behaviors among people on probation. Presentation at the Addiction Health Services Research Conference, Savannah, GA.

Muiruri, R., Pankow, J., Lehman, W. E. K., Joe, G. W., Knight, K., & Flynn, P.  (2018, October). Methodological considerations for conducting research with adults in community and residential corrections settings. Poster presented at the Addiction Health Services Research Conference, Savannah, GA.

Pankow, J., Johnson, A., Muiruri, R., Knight, K., Flynn, P., Joe, G. W., & Lehman, W. E. K. (2018, October). Using StaySafe Decision-making App in Probation Settings: Qualitative Experiences from Study Participants.  Poster presented at the Addiction Health Services Research Conference, Savannah, GA.

Lehman, W. E. K., Pankow, J., Gray, J., & Rowan, G. A. (2015, March). StaySafe: An app to help probationers make better decisions on health risk behaviors. Poster presentation at the Academic and Health Policy Conference on Correctional Health, Boston, MA.

Gray, J. S., Pankow, J., Lehman, W. E. K., Rowan, G. A., & Knight, K. (2014, October). “There’s an app for that”: A novel tool to help community correction populations learn strategies to decrease HIV risk behaviors after release. Presented at the Addiction
Health Services Research Conference, Boston, MA.

Lehman, W. E. K., Pankow, J., Knight, K., Rowan, G. A., & Gray, J. S. (2014, October). Staying safe in the community: Adaptation of WaySafe for helping probationers make better decisions about their health risks. Presented at the Addiction Health Services Research Conference, Boston, MA.