The major goal of epidemiology consists of the promotion of public health through the creation of appropriate programs for high-risk populations (Fletcher, Fletcher, & Fletcher, 2013). Apart from that, the development of measurements for the outcomes of such programs is also a necessity. Indeed, the measurements can be employed as a part of a program’s planning while also producing the data on the success of the program, which can be used to improve it or other similar programs (Perrin, 2014).
An Advanced Practice Nurse (APN) needs to be familiar with both processes to be able to contribute to public health efforts (American Association of Colleges of Nursing [AACN], 2006). In the present paper, the development of the interventions for the incarcerated population at risk of mental illnesses is going to be discussed, and the mechanisms of offering outcomes measurements for them will be considered.
Evidence-Based Interventions: An Epidemiological Perspective
To understand the process of the development of pertinent interventions, the epidemiological triangle might be helpful because it allows determining the factors that can be modified to reduce a population’s risks (Stanhope & Lancaster, 2014). The agents of mental disorders depend on the specific illness, which is why they are not considered in this paper, but the host and environment have some factors that are more or less typical for mental issues in general.
With respect to the phenomena that are pertinent to the host, various addictions can be controlled (Rich, Allen, & Williams, 2014). From the perspective of the environment, multiple stressors, and sources of traumatic experience or anxiety that can lead to mental disorders may also be controlled (ECRI Institute Evidence-Based Practice Center [EIEBPC], 2013). Apart from that, a major environmental issue in correctional settings is the problem of screening and treatment, which can also be modified (EIEBPC, 2013; Martin, Colman, Simpson, & McKenzie, 2013). In summary, the epidemiological analysis implies that multiple risk factors for the incarcerated population with mental issues can be controlled, which calls for the development of appropriate interventions.
Primary prevention measures are a major instrument in promoting mental health in incarcerated populations. They are aimed predominantly at the promotion of the behaviors and settings that reduce risks and the discouragement of the practices that have the opposite effect (Fazel, Hayes, Bartellas, Clerici, & Trestman, 2016; Fletcher et al., 2013). For instance, the development of a safe environment is critical for the mental health of incarcerated populations (Fazel et al., 2016).
An example of an intervention that can improve the safety of the environment is the training of the staff of an institution, including healthcare providers and officers. For instance, the training intervention by Melnikov, Elyan-Antar, Schor, Kigli-Shemesh, and Kagan (2016) was aimed at reducing mental issues-related bias in the officers of a correctional institution. The study provides evidence that suggests that such educational efforts are capable of reducing stigma, which implies that their implementation at a larger scale is desirable for the promotion of inclusive, bias- and stigma-free environment for the incarcerated population. In turn, such an environment would be expected to be more conducive to various levels of prevention (for example, screening) and characterized by a reduced exposure of patients to stigma-related stress.
Secondary and tertiary prevention measures should also be of importance for the discussed population (Fletcher et al., 2013). It appears that the common intervention employed in correctional settings is the intake screening, but institutions need to provide follow-up assessments, especially for at-risk prisoners (Fazel et al., 2016). Martin et al. (2013) state that screening is crucial for the mental health strategy in correctional institution populations since the timely determination of mental issues ensures timely care, which explains the rationale for the approach.
An example of an evidence-based intervention that is geared towards tertiary prevention is the integrated dual disorder treatment (EIEBPC, 2013, p. 6). This intervention treats mental issues and addictions simultaneously, and its major advantage consists of it being tailored to work specifically with the people who suffer from both conditions. Such combinations of issues are rather common in prisons: according to Rich et al. (2014), 70% of inmates with mental disorders report the problem of substance abuse as well, which highlights the appropriateness of the intervention and its ability to address relevant risks. In summary, the interventions that are offered to the incarcerated population can be explained by the need to modify its exposure to various risks.
Identification of Measurement Outcomes for Identified Interventions
Outcomes evaluation is a rather complex activity, and the measurements need to be customized to the intervention’s specifics (Centers for Disease Control and Prevention & Program Performance and Evaluation Office, 2017). For the program developed by Melnikov et al. (2016), the key outcome would be the changes in stigmatization exhibited by the officers. The authors measure this outcome with the help of a three-component questionnaire that collects the data on cognitive, affective, and behavioral stigmatization.
Similarly, the primary outcomes of the dual disorder treatment are the improvement of the patient’s condition with respect to mental issues and their rehabilitation from addiction. Both outcomes can be measured with the help of appropriate tools; for instance, there exists a variety of assessment scales for depression, dementia, and other mental disorders (Karlin, Visnic, McGee, & Teri, 2014; Martin et al., 2013).
On the other hand, the screening interventions that are proposed by Fazel et al. (2016) would be evaluated by documenting the events of screening and monitoring of the people who are considered to be at risk of mental issues development. These criteria would be able to track the intervention’s ability to improve access to screening. Thus, the three examples illustrate the fact that the aims of interventions determine the outcome criteria that need to be considered.
Implications of the Project for the APN Clinical Practice: A Conclusion
The present paper demonstrates the fact that the creation of the evidence-based interventions for the incarcerated populations that are at risk of developing mental issues appears to be connected to some epidemiological considerations, in particular, possible risk factors. Some of the modifiable factors include the specifics of the host’s lifestyle and environment, which results in the development of interventions aimed at the reduction of substance abuse, the improvement of the access to screening and treatment, and the promotion of the safety of the patients. The outcomes measurements for the interventions need to be tailored to their specifics.
The project has contributed to my professional growth with respect to the seventh essential suggested by AACN (2006), which focuses on an APN’s ability to contribute to the improvement of the nation’s health. Moreover, the project also improved my knowledge pertinent to the eighth essential, which describes the advanced nursing practice. In summary, the project has provided me with an opportunity to review the topic of epidemiology and connect it to my field of practice, which is mental care in correctional institutions. As a result, the implications of the project are of direct use to me.
American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advance nursing practice. Washington, DC: Author.
Centers for Disease Control and Prevention, & Program Performance and Evaluation Office. (2017). A framework for program evaluation. Web.
ECRI Institute Evidence-Based Practice Center. (2013). Interventions for adult offenders with serious mental illness. Web.
Fazel, S., Hayes, A., Bartellas, K., Clerici, M., & Trestman, R. (2016). Mental health of prisoners: prevalence, adverse outcomes, and interventions. The Lancet Psychiatry, 3(9), 871-881. Web.
Fletcher, R., Fletcher, S., & Fletcher, G. (2013). Clinical epidemiology. Philadelphia, PA: Lippincott Williams & Wilkins.
Karlin, B., Visnic, S., McGee, J., & Teri, L. (2014). Results from the multisite implementation of STAR-VA: A multicomponent psychosocial intervention for managing challenging dementia-related behaviors of veterans. Psychological Services, 11(2), 200-208. Web.
Martin, M., Colman, I., Simpson, A., & McKenzie, K. (2013). Mental health screening tools in correctional institutions: A systematic review. BMC Psychiatry, 13(1), 1-10. Web.
Melnikov, S., Elyan-Antar, T., Schor, R., Kigli-Shemesh, R., & Kagan, I. (2016). Nurses teaching prison officers: A workshop to reduce the stigmatization of prison inmates with mental illness. Perspectives in Psychiatric Care, 2016, 1-8. Web.
Perrin, K. (2014). Essentials of planning and evaluation for public health. Burlington, MA: Jones & Bartlett Learning, LLC.
Rich, J., Allen, S., & Williams, B. (2014). The need for higher standards in correctional healthcare to improve public health. Journal of General Internal Medicine, 30(4), 503-507. Web.
Stanhope, M., & Lancaster, J. (2014). Public health nursing. London, UK: Elsevier Health Sciences.