The utilization of violence risk instruments in forensic populations is increasing and a plethora of empirical investigations support their ability to predict recidivistic outcomes. However, the generalizability of these findings to culturally diverse populations is problematic given dissimilarities in cultural traditions, norms, and experiences. The present study explored this subject in relation to Aboriginal Australians. First, a concert of violence risk markers that are more prevalent among Aboriginal Australian offenders compared with non-Aboriginal offenders were examined in light of their social and historical context. Next, studies employing violence risk instruments on cohorts of Aboriginal Australian offenders were reviewed. Findings demonstrated moderate predictive accuracy for violence and commensurate utility with non-Aboriginal offenders although results should be treated with caution due to the paucity of available studies for consideration. Implications for clinical practice and culturally appropriate assessment models are discussed.

Background and aims Opioid agonist treatment is effective but resource intensive to administer safely in custodial settings, leading to significant under‐treatment of opioid dependence in these settings world‐wide. This study assessed the safety of subcutaneous slow‐release depot buprenorphine in custody. Design Open‐label, non‐randomized trial. Setting Correctional centres in New South Wales, Australia. Participants Sixty‐seven men and women, aged ≥ 18 years of various security classifications with a diagnosis of moderate to severe DSM‐5 opioid use disorder currently serving a custodial sentence of ≥ 6 months were recruited between November 2018 and July 2019. Patients not in opioid agonist treatment at recruitment commenced depot buprenorphine; patients already stable on oral methadone treatment were recruited to the comparison arm. Intervention and comparator Depot buprenorphine (CAM2038 weekly for 4 weeks then monthly) and daily oral methadone. Measurements Safety was assessed by adverse event (AE) monitoring and physical examinations at every visit. Participants were administered a survey assessing self‐reported diversion and substance use at baseline and weeks 4 and 16. Findings Retention in depot buprenorphine treatment was 92.3%. Ninety‐four per cent of patients reported at least one adverse event, typically mild and transient. No diversion was identified. The prevalence of self‐reported non‐prescribed opioid use among depot buprenorphine patients decreased significantly between baseline (97%) and week 16 (12%, odds ratio = 0.0035, 95% confidence interval = 0.0007–0.018, P < 0.0001). Conclusions This first study of depot buprenorphine in custodial settings showed treatment retention and outcomes comparable to those observed in community settings and for other opioid agonist treatment used in custodial settings, without increased risk of diversion.

BackgroundAboriginal Australians are more likely than other Australians to cycle in and out of prison on remand or by serving multiple short sentences—a form of serial incarceration and institutionalisation. This cycle contributes to the over-representation of Aboriginal Australians in prison and higher rates of recidivism. Our research examined how primary health care can better meet the health care and social support needs of Aboriginal Australians transitioning from prison to the community.MethodsPurposive sampling was used to identify 30 interviewees. Twelve interviews were with Aboriginal people who had been in prison; ten were with family members and eight with community service providers who worked with former inmates. Thematic analysis was conducted on the interviewees’ description of their experience of services provided to prisoners both during incarceration and on transition to the community.ResultsInterviewees believed that effective access to primary health care on release and during transition was positively influenced by providing appropriate healthcare to inmates in custody and by properly planning for their release. Further, interviewees felt that poor communication between health care providers in custody and in the community prior to an inmate’s release, contributed to a lack of comprehensive management of chronic conditions. System level barriers to timely communication between in-custody and community providers included inmates being placed on remand which contributed to uncertainty regarding release dates and therefore difficulties planning for release, cycling in and out of prison on short sentences and being released to freedom without access to support services.ConclusionsFor Aboriginal former inmates and family members, release from prison was a period of significant emotional stress and commonly involved managing complex needs. To support their transition into the community, Aboriginal former inmates would benefit from immediate access to culturally- responsive community -primary health care services. At present, however, pre-release planning is not always available, especially for Aboriginal inmates who are more likely to be on remand or in custody for less than six months.

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The objective of this review was to synthesise evidence on the health and social support needs of Aboriginal and Torres Strait Islander people leaving prison and on programs which aid successful community re-entry. A systematic literature review was undertaken of peer-reviewed and grey literature published between 2001 and 2013, focusing on the post-release needs of Aboriginal and Torres Strait Islander adults and pre-and post-release programs. Aboriginal and Torres Strait Islander people have high health and social support needs on leaving prison. There is little literature evidence that re-entry programs commonly consider health needs, support linkages with primary care or Aboriginal Medical Services, or are designed in consideration of the particular needs of Aboriginal and Torres Strait Islander people. In the absence of evaluative evidence on re-entry programs in this group, we have synthesised the best practice recommendations. Re-entry programs must be culturally competent in design and delivery, holistic, take a longterm view, involve families and communities, demonstrate interagency coordination and promote linkages between prison and community-based services. There is an urgent need for accessible pre-and post-release programs which meet the particular needs of Aboriginal and Torres Strait Islander people, including their health needs. Programs must be flexible, comprehensive and accessible to those on remand or with short sentences. Stronger linkage with primary care and Aboriginal and Torres Strait Islander community controlled health organisations is recommended.