背景:创伤性脑损伤(TBI)在与刑事司法系统(CJS)相交或涉及的个体中不成比例地普遍存在。如果没有适当的照顾,TBI相关损害,健康的交叉社会决定因素,在CJS设置中缺乏TBI意识会导致句子变长,严重的纪律指控,和累犯。然而,有证据表明,大多数临床实践指南(CPG)忽视了公平性,因此,弱势群体的需要。因此,这篇综述解决了这个研究问题:“(1)在多大程度上与TBICPG中考虑的CJS相交,(2)在CJS的CPG中考虑的TBI,和(3)CJS在CPG中考虑的权益?\“。
结果:从电子数据库中识别出CPG(MEDLINE,Embase,CINAHL,PsycINFO),有针对性的网站,Google搜索,以及2021年11月和2023年3月(TBI的CPG)以及2022年5月和2023年3月(CJS的CPG)的已识别CPG的参考列表。仅包括TBI的CPG或CJS的CPG。我们计算了包含TBI或CJS特定内容的CPG的比例,进行了定性内容分析,以了解有关TBI和CJS的证据如何集成到CPG中,并利用股权评估工具来了解是否以及如何考虑股权。本综述包括57个用于TBI的CPG和6个用于CJS的CPG。TBI的十四个CPG包括与CJS相关的信息,但只有1人提出了具体建议,在法医背景下考虑职业评估期间的法律影响。CJS的两个CPG承认监狱中TBI的患病率,一个特别建议在健康评估期间考虑TBI。TBI的CPG和CJS的CPG都提供了特定于CJS单个方面的证据,主要是治安和矫正。CJS的CPG中缺乏公平最佳做法的使用和弱势群体在发展过程中的参与。我们承认审查的局限性,包括我们的搜索是用英语进行的,因此,在这篇评论中,我们可能错过了其他非英语语言的CPG。我们进一步认识到,我们无法对未纳入CPG的证据发表评论,因为我们没有系统地搜索与CJS相交的TBI个体的研究,在CPG之外。
结论:本综述的结果为考虑CJS参与TBICPG和提高CJSCPG的公平性提供了基础。进行研究,包括调查与CJS所有方面相交的个人的TBI筛查过程,在准则制定中利用公平评估工具是提高这一弱势群体医疗保健公平的关键步骤。
BACKGROUND: Traumatic brain injury (TBI) is disproportionately prevalent among individuals who intersect or are involved with the criminal justice system (CJS). In the absence of appropriate care, TBI-related impairments, intersecting social determinants of health, and the lack of TBI awareness in CJS settings can lead to lengthened sentences, serious disciplinary charges, and recidivism. However, evidence suggests that most clinical practice guidelines (CPGs) overlook equity and consequently, the needs of disadvantaged groups. As such, this review addressed the research question \"To what extent are (1) intersections with the CJS considered in CPGs for TBI, (2) TBI considered in CPGs for CJS, and (3) equity considered in CPGs for CJS?\".
RESULTS: CPGs were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of identified CPGs on November 2021 and March 2023 (CPGs for TBI) and May 2022 and March 2023 (CPGs for CJS). Only CPGs for TBI or CPGs for CJS were included. We calculated the proportion of CPGs that included TBI- or CJS-specific content, conducted a qualitative content analysis to understand how evidence regarding TBI and the CJS was integrated in the CPGs, and utilised equity assessment tools to understand if and how equity was considered. Fifty-seven CPGs for TBI and 6 CPGs for CJS were included in this review. Fourteen CPGs for TBI included information relevant to the CJS, but only 1 made a concrete recommendation to consider legal implications during vocational evaluation in the forensic context. Two CPGs for CJS acknowledged the prevalence of TBI among individuals in prison and one specifically recommended considering TBI during health assessments. Both CPGs for TBI and CPGs for CJS provided evidence specific to a single facet of the CJS, predominantly in policing and corrections. The use of equity best practices and the involvement of disadvantaged groups in the development process were lacking among CPGs for CJS. We acknowledge limitations of the review, including that our searches were conducted in English language and thus, we may have missed other non-English language CPGs in this review. We further recognise that we are unable to comment on evidence that is not integrated in the CPGs, as we did not systematically search for research on individuals with TBI who intersect with the CJS, outside of CPGs.
CONCLUSIONS: Findings from this review provide the foundation to consider CJS involvement in CPGs for TBI and to advance equity in CPGs for CJS. Conducting research, including investigating the process of screening for TBI with individuals who intersect with all facets of the CJS, and utilizing equity assessment tools in guideline development are critical steps to enhance equity in healthcare for this disadvantaged group.