Patient, medical and legal perspectives on reentry: the need for a low-barrier, collaborative, patient-centered approach

Zoe Pulitzer,Maria Box,Ank E Nijhawan,Laura Hansen,Yordanos M Tiruneh

doi:10.1186/s40352-021-00161-7

Abstract

BackgroundWorldwide, the United States has the highest incarceration rate per capita. Thousands of people are released from US correctional facilities each year, including many who are impacted by HIV infection and substance use disorder (SUD), two frequently comorbid conditions that present multiple challenges upon reentry. Reentry and care engagement research involving justice-involved people with HIV (PWH) with comorbid SUD has been largely limited to the perspective of those released. To formulate effective interventions for this population aimed at maintaining health and reducing recidivism, it is crucial to collect data from formerly incarcerated individuals with firsthand experience of the reentry process as well as other actors within the reentry framework. Insights from medical and legal service providers working in reentry systems have the potential to address key implementation concerns. To inform an intervention aimed at helping recently-released individuals PWH and SUD, we conducted a qualitative study to assess barriers and facilitators to community reentry from the perspectives of diverse consumers and providers of medical, legal, and reentry services.ResultsFifteen stakeholders within Dallas County participated in in-person interviews. Results indicated that 1) Patients/clients emphasized psychosocial support and individual attitude more than medical and legal participants, who chiefly focused on logistical factors such as finances, housing, and transportation; 2) Patients/clients expressed both medical and legal needs during the reentry period, though medical providers and participants from legal entities mainly expressed concerns limited to their respective scopes of work; 3) All three participant groups underscored the need for a low-barrier, collaborative, patient-centered approach to reentry with the goal of achieving self-sufficiency.ConclusionsFindings support and extend existing literature detailing the barriers and facilitators to successful reentry. Our findings underscore the notion that an effective reentry intervention addresses both medical and legal needs, includes an individualized approach that incorporates psychosocial needs, and focuses on establishing self-sufficiency.

Highlights

The United States has the highest incarceration rate per capita globally, with 830 out of every 100,000 adults in prison or jail (Maruschak & Minton, 2020), many of whom are released back into their respective communities each year
Patients/clients comprised individuals who had a history of incarceration, some living with HIV and/or substance use disorder (SUD), and previously-incarcerated individuals receiving reentry services at XXX [re-entry agency]
Three major themes emerged from the data: 1) Patients/clients highlighted the significance of psychosocial support and individual outlook more than medical and legal participants, who primarily focused on logistical factors such as finances, housing, and transportation; 2) Patients/clients expressed both medical and legal needs post-incarceration, though medical providers and participants from legal entities expressed concerns specific to their respective scopes of work; 3) A commonly shared perspective across participant groups emphasized the need for a low-barrier, collaborative, patient-centered approach to reentry with the goal of achieving selfsufficiency

Summary

Introduction

The United States has the highest incarceration rate per capita globally, with 830 out of every 100,000 adults in prison or jail (Maruschak & Minton, 2020), many of whom are released back into their respective communities each year. Among PWH, recidivism (Fu et al, 2013) and SUD (Wilson et al, 2011; Zgoba et al, 2020) may result in interruptions in community-based care These concurrent legal and medical issues highlight the complex nature of reentry after incarceration for PWH and people with SUD, necessitating multidisciplinary solutions. Thousands of people are released from US correctional facilities each year, including many who are impacted by HIV infection and substance use disorder (SUD), two frequently comorbid conditions that present multiple challenges upon reentry. To inform an intervention aimed at helping recently-released individuals PWH and SUD, we conducted a qualitative study to assess barriers and facilitators to community reentry from the perspectives of diverse consumers and providers of medical, legal, and reentry services

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