Candidates should also be made aware of their contractual responsibilities to disclose any new or ongoing criminal investigations or proceedings during their employment. DBS checking only reveals criminal activity in the UK, it will not reveal criminal activity which has taken place abroad, whether the applicant is a British National or not. For non-UK nationals, it is important to carry out a criminal record disclosure on the home country. Having carried the appropriate criminal record check, employers should consider the information carefully before deciding whether to employ a candidate, ensuring the safety of patients and other healthcare providers.
Criminal background checks for the healthcare industry. Total time incarcerated was logarithmically transformed to account for the nonlinear nature of the measure. We selected covariates based on a priori hypotheses of the characteristics likely to confound the association of interest. We examined this interaction based on prior evidence of an additive effect of these stigmatized characteristics in other domains such as employment Pager et al.
We performed all analyses using SAS version 9. All p values are 2-tailed.
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Individuals reporting criminal record discrimination by healthcare workers were significantly older mean age, Characteristics of total sample and sample stratified by self-reported lifetime healthcare discrimination based on criminal record. In multivariable analyses adjusting for sociodemographic and correctional characteristics Model 2 , self-reported criminal record discrimination by healthcare workers remained significantly associated with frequent ED utilization odds ratio [OR] 2.
In Model 3, the association between criminal record discrimination by healthcare workers and frequent ED utilization OR 2. P values represent pairwise comparisons using chi-square test. Groups are mutually exclusive. Multivariable logistic regression models estimating the association between self-reported criminal record discrimination by healthcare workers and healthcare utilization.
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To our knowledge, criminal record discrimination by healthcare workers has not previously been examined. These studies were conducted among active drug users in New York City and assessed self-reported discrimination based on criminal record in any setting. Our findings support and extend this work by focusing on self-reported discrimination based on criminal record experienced during interactions with doctors, nurses, psychiatrists and other healthcare workers. Our study adds to a growing field of research on discrimination in healthcare. Also, individuals who reported a history of healthcare discrimination based on criminal record were more likely to have obtained some post-secondary education.
Both findings may reflect the increased salience of the experience of discrimination among these relatively advantaged groups. These groups may also have experienced discrimination for the first time due to incarceration. Alternatively, less advantaged groups may be less likely to report discrimination because it is a common event in their lives. Further, among groups with multiple stigmatized identities e. These multiple stigmatized identities may have an additive, negative effect on healthcare experiences as has been demonstrated in studies examining experiences in the job market Pager ; Pager et al.
Individuals who reported a history of criminal record discrimination by healthcare workers were older and had more extensive incarceration histories. This finding may reflect greater time spent incarcerated and therefore at risk of discrimination associated with incarceration. Alternatively, unmeasured factors associated with length and frequency of prior incarceration may also be associated with self-reported discrimination. For example, more serious criminal offenses result in longer sentences and may be associated with differential or "unfair" treatment by healthcare workers.
Longitudinal linkages between more granular criminal justice and health-related data, though challenging, are essential both for testing such a hypothesis as well as for clinical quality improvement Matejkowski et al. This finding has several potential explanations. The ED is often the initial point of contact for incarcerated individuals who need to be transferred outside the correctional system to receive healthcare.
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Providers caring for a patient in an orange jumpsuit and shackles likely bring biases, whether explicit or implicit, to these encounters. Alternatively, ex-prisoners in the community who perceive discrimination in healthcare settings may choose to utilize the ED more frequently given the episodic, relatively anonymous nature of these interactions. In general, while disparities in emergency care have been documented Pletcher et al.
Contrary to our hypothesis, we did not find an association between criminal record discrimination by healthcare workers and infrequent primary care utilization. We believe the impact of criminal record discrimination on the patient-provider relationship warrants further study given its potential to both mediate the significant health risks following release from prison as well as to provide a point of intervention to improve health outcomes for this vulnerable group.
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The results of this study should be considered in light of its limitations. First, study data are cross-sectional and therefore do not allow inferences of causation. Though we hypothesized that experiences of criminal record discrimination affect healthcare utilization patterns, we cannot rule out reverse causation, in which greater ED utilization increases exposure to criminal record discrimination. This latter explanation would still highlight a need to better understand the healthcare experiences of individuals in correctional custody, particularly those experiences occurring in ED settings.
Second, participants were each in male-female relationships, were recently released from prison and were recruited from a single region in California and therefore may not be generalizable to other ex-prisoner populations or settings. Specifically, men in romantic relationships report less discrimination than their counterparts not in relationships Kessler et al.
However, recent release from prison may make experiences of discrimination more salient and thereby overestimate this exposure compared to individuals with more remote criminal justice involvement Kressin et al. Of note, important attributes of our study sample such as rates of common chronic diseases and reported use of correctional healthcare are similar to those found in the prison population nationally Wilper et al.
Third, the small size of our sample raises the possibility of a Type II error. Inclusion of individuals with criminal justice involvement and assessment of criminal history in larger data collection efforts is needed Ahalt et al. The findings of this pilot study are hypothesis-generating but do highlight the need for such instruments to be validated in criminal justice populations.
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Finally, as validated measures of healthcare utilization were not present in our data, we used the most clinically relevant utilization outcomes available. Further study using validated measures and confirmed by medical record or claims data is needed. We also identified a non-significant trend toward an association between this experience of discrimination and decreased utilization of primary care services. We believe our findings may have implications for both providers as well as for policy makers.
For healthcare workers and policymakers alike, greater understanding of criminal record discrimination may offer opportunities to increase patient engagement and improve access for this vulnerable population. The authors would like to thank Samantha Dilworth for her assistance with study coordination and data management and the Relate Project participants, interviewers, and investigators for their contributions to this study. Funding agencies had no role in the design, collection, analysis or interpretation of data, the writing of the manuscript or in the decision to submit the manuscript for publication.
Competing interests. JWF led the conception and design, analysis and interpretation of data, and drafted the manuscript. EAW made substantial contributions to conception and design and to interpretation of data, and revised the manuscript critically for important intellectual content.
MNS made substantial contributions to the interpretation of data, and revised the manuscript critically for important intellectual content. HL made substantial contributions to the interpretation of data, and revised the manuscript critically for important intellectual content.
MC made substantial contributions to conception and design, to acquisition and interpretation of data, and revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript. Joseph W Frank, Email: ude. Emily A Wang, Email: ude. Marcella Nunez-Smith, Email: ude. Hedwig Lee, Email: ude. With more locales putting a spotlight on housing availability and the way that landlords operate, new rules and regulations are increasingly common.
For landlords, it's a concerning change in operations. Business Personal Resellers. Crimes like theft, embezzlement, and fraud are red flags, as are past issues with drugs.