Reentry Programs Research Articles

The relationship between existential isolation and suicidal ideation among formerly incarcerated individuals

Background and purpose Formerly incarcerated people die by suicide at a rate 6.75 times higher than the general population. In this study we ask whether existential isolation, the feeling of being alone in one’s subjective experiences, offers new insights into this staggering statistic. We specifically ask whether existential isolation predicts suicidal ideation among formerly incarcerated individuals even after accounting for their levels of interpersonal isolation, emotional support, and instrumental support. Method We examined cross-sectional survey data from American participants (n = 946) recruited over the Amazon Mechanical Turk (MTurk) platform. Results Consistent with prediction, we found that people with an incarceration history reported more existential isolation, but not more interpersonal isolation, than those without an incarceration history. A hierarchical regression analysis revealed that existential isolation explained additional variance in suicidal ideation beyond what was explained by interpersonal isolation, instrumental support, and emotional support. Fisher’s r-to-z transformations demonstrated that the magnitude of the relationship between existential isolation and suicidal ideation was stronger among those with an incarceration history than among those without. Finally, existential isolation mediated the relationship between incarceration and suicidal thoughts, even when holding constant other predictors of suicidal ideation. Conclusion Reentry programs may target existential isolation among formerly incarcerated individuals to improve emotional wellbeing.

Infectious Disease Education in a Carceral Setting: Insights from a Jail-Based Medical Student-Led Health Literacy Initiative.

Incarceration is associated with adverse health outcomes, including higher rates of infectious diseases. Poor health literacy in this population is a likely contributing factor, making health education a potential tool to help address these health disparities. This article aims to describe the implementation of a novel medical student-led educational initiative in the jail setting as a tool to promote health literacy and decrease the infectious disease burden in the correctional setting. A four-part infectious disease health education curriculum was developed and tailored to a carceral context. The course was offered on a voluntary basis to members of a reentry program at a local county jail. Pre- and postcourse surveys were used to evaluate the course effectiveness. The results demonstrated a statistically significant increase in the participants' reported confidence for recognizing the symptoms of and seeking appropriate treatment for common infections, including sexually transmitted, respiratory, and blood-borne infections. To the authors' knowledge, this is one of the first medical student-led programs of its kind to be described in existing literature. This program hopes to continue refining its curricular offerings and serve as a model for medical schools across the country to increase trainee engagement.

Building Bridges: Exploring Support Systems of Justice-Involved Individuals

Having access to a person who encourages prosocial behavior and discourages antisocial behavior for justice-involved individuals is a key factor in the reentry process. The gender-responsive literature suggests that social support is an especially salient factor for justice-involved women. However, limited research has examined positive support person’s willingness to become involved in the reentry process. Using a sample of 179 justice-involved men and women enrolled in a reentry program designed to train support persons in rehabilitative skills, the current study aims to examine the willingness of support persons of justice-involved individuals to attend a reentry program. The findings demonstrated that less than half of justice-involved individuals had support persons participate in the program. Furthermore, women were significantly less likely to have support persons attend the reentry program than men. The implications of these findings for reentry and the gender-responsive framework are discussed.

COVID-19 pandemic and women transitioning from incarceration: a study of online health information seeking among underserved and marginalized women

ABSTRACT Based on interviews with 118 women recently released from incarceration in the U.S. Midwest, this study examines changes in their online health information consumptions and evaluations throughout the COVID-19 pandemic (2020–2022). Findings show that women transitioning from incarceration, who are often marginalized at the intersection of gender, socioeconomic status, and race, faced challenges navigating and assessing online health information during the pandemic. We use a feminist framework in analyzing online health information seeking and assessments among women recently released from incarceration while acknowledging intersectional marginality experienced by this population. Given the limited existing research on reentry programs focusing specifically on justice-involved women, our study contributes to developing and improving health and information literacy programs for this underserved and marginalized population.

"Even Though the System Had Failed Him His Entire Life, We Were Failing Him Yet Again": How Clinical, Welfare, and Penal Medicine Interact to Drive Health Inequities and Medical Moral Injury.

Adam, a justice-involved young man, was brought into the emergency department at the county hospital in cardiogenic shock due to a recurring episode of injection-drug-use-related infective endocarditis (IDU-IE). Adam had initiated injection opioid use in prison. He was surgically treated for the previous episodes of IDU-IE but was unable to fully recover due to limitations in care within penal medicine. This case report explores the prison as a determinant of health, interactions between clinical, welfare, and penal medicine, to produce and maintain health inequities, and structural drivers of physician moral injury through an interview with Adam and reflexive writings from emergency medicine physicians. This case demonstrates the need for three types of structural health interventions: (1) restorative justice, community-based reentry programs, and housing as welfare medicine, (2) increased harm reduction services across healthcare, especially penal medicine, and (3) equitable institutional protocols (contrary to ambiguous guidelines) to treat clinical conditions like IDU-IE that disproportionately impact structurally vulnerable patients.

Invited commentary: unveiling the grim reality-suicide mortality among formerly incarcerated individuals in North Carolina.

In the article by Fitch etal. (Am J Epidemiol 2024;193(3):489-499), the authors highlight the concerning prevalence of suicide mortality among formerly incarcerated individuals in North Carolina. Their retrospective study reveals a doubled suicide risk postrelease, with notable disparities among demographic groups. Urgent interventions are needed, including comprehensive reentry programs and systemic reforms to address structural inequalities. I suggest tailored support services to mitigate suicide risks and promote successful community reintegration, advocating for equity, justice, and human dignity in postrelease efforts.

Project Impact: A Public Community College Campus–Based Support and Reentry Program for Justice-Impacted Students in New York City

Background: Between 70 million and 100 million Americans have a record of interaction with the criminal legal system, a group facing stigma and discrimination in civic participation, housing, employment, and education. Justice-impacted people face collateral consequences in the community, making reentry programs essential to success at reintegration. Focus of Study: Project Impact (PI) at the Borough of Manhattan Community College/City University of New York (BMCC/CUNY) supports students impacted by the criminal legal system. PI provides direct services to justice-impacted students through an extensive peer mentoring program and a high school equivalency program, and by offering college credit–bearing courses to students presently incarcerated in partnership with John Jay College’s Prison-to-College Pipeline. PI defines “justice impacted” expansively as students who have been formerly incarcerated, have family who have been incarcerated or arrested, have had issues in family court, or in any other way have been significantly affected by the criminal legal system. Research Design/Conclusions: This evaluation provides unequivocal evidence of the strong, positive impact that PI is making, serving as a rare campus-based reentry program within a community college in New York City.

Reframing reentry: Understanding how reentry programming affects the well-being and quality of life of returning citizens.

This study examined the experiences returning citizens (RCs) have in participating in different reentry programs and how these experiences may lead to improved well-being and quality of life (QOL). We conducted 14 semi-structured interviews with RCs participating in employment-oriented reentry programs. The interviews focused on participants' reentry programming experience and areas affecting their well-being (e.g., housing, education, financial stability). QOL was enhanced for RCs when they were able to access stable housing, develop supportive relationships, have a job that permitted them the resources needed to live independently, and increase their perceptions of self-efficacy and social capital. While reentry programs maintain a focus on employment for RCs, housing, healthy relationships, and opportunities for increasing self-efficacy and social capital are tied to well-being and QOL among RCs. Reentry programs have the potential to influence a variety of factors at multiple levels that shape well-being and QOL, and in turn employment and recidivism, among RCs.

Examining the Strengths and Challenges of a Smart Reentry Program: Lessons Learned

Although reentry programming has grown, little is known about the process of developing reentry programming that utilizes peer support. Peer support is commonly utilized along side evidence-based practices in other service delivery areas (e.g., mental health), and is increasingly used during reentry, yet little is known about whether this practice is effective at reducing recidivism. This study examines a Smart Reentry program in an urban, Midwestern city. Drawing on 18 interviews with peer guides and family support specialists across two time points, and program participants at one time point, the authors examine the challenges and strengths related to staff training and development, program culture, and participant engagement. Results demonstrate the strengths of a family-centered model of reentry programing, and the challenges of working with the department of correction staff and paraprofessional peer guides within a professional environment. Suggestions are offered for programming utilizing similar models of paraprofessionals.

Attrition from Jail Reentry Program Increases Recidivism

Reentry programs represent an increasingly popular method to reduce recidivism for individuals exiting prison and jail systems throughout the United States. Most evaluations tend to focus on recidivism as the primary outcome of interest. Attrition, however, can function an important supplementary measure that complements recidivism outcomes. To demonstrate, we analyze a jail reentry program built around peer navigators serving as staff members that refer participants to necessary support services while also serving as a mentor to participants exiting jail. We use a combination of general linear models (GLMs), Mahalanobis distance matching (MDM), and panel regression to both predict attrition and compare recidivism outcomes between three attrition groups: program completers, program quitters, and matched controls. Participants that successfully completed the program did not avoid new convictions or reincarceration significantly more or less than matched controls. Participants that quit the program, however, saw significantly higher conviction and reincarceration rates compared to matched controls. The nuance added to our program evaluation by adding attrition as a differential factor is worth consideration by other reentry programs who may not be realizing the full picture of their results by presenting recidivism outcomes alone.

565 Pediatric Patients with Post-Burn Amputations Report Worse Long-Term Physical Function but Not Self Appearance

Abstract Introduction Amputation after burn injury may improve survival rates; however, the physical changes and functional impairments resulting from amputation can have long-term consequences. A prior Burn Model System (BMS) national database study found that post-burn amputation among adults was negatively correlated with mental health scores but positively correlated with physical function scores at 6-months post-burn. However, no study has examined long-term outcomes associated with post-burn amputation in the pediatric population. This study investigates longitudinal functional and psychosocial outcomes among pediatric burn patients with amputations. Methods Pediatric participants (8 – 17 years old) enrolled in the BMS database between 2015 – 2023 with post-burn amputations were included. Participants with amputations were matched using nearest-neighbor matching to those without, based on burn location, age and % total burn surface area. Primary outcomes were the PROMIS-25 v2.0 Physical Function and the Child Burn Outcomes Questionnaire: appearance sub-score, measured at 6-, 12- and 24-months post-burn. In addition to cross-sectional pairwise analyses at each time-point, linear mixed effects models were used to assess differences in outcomes between those with and those without amputations after adjusting for time while accounting for repeated measures. Additional linear mixed effects models, including an interaction between amputation status and time, were conducted to assess whether the change in outcome scores across time differed between those with and without amputations. A two-sided significance level of 0.05 was used to determine statistical significance. Results In this study, 17 participants had amputations and 17 did not. A total of 7 participants had upper amputation only, 1 had lower amputation only, 2 had upper and lower amputation and 7 were unknown. Amputation was significantly associated with lower physical function scores (9.3 points lower, p=0.006) after adjusting for follow-up time-points. However, there was no evidence that the difference in physical function scores worsened or improved over time. Pairwise analyses at each time-point found those with amputations reported significantly lower physical function scores at 24-months post-burn (54.9 ±11.6 vs. 66 ±5, p=0.013). No significant differences were found in appearance scores or in the change in appearance scores. Conclusions Amputation was significantly associated with worse physical function scores. Participants with amputation fared as well in appearance scores as those without amputation. Pediatric burn patients with amputations might benefit from tailored amputee-specific rehabilitation services, amputee peer support, and school reentry programs. Applicability of Research to Practice This study can be used to guide recommendations for physical/occupational therapy and other rehabilitative services available to pediatric burn patients with amputations.

Rural Jail Reentry Non-Clinical Case Management: An Examination of the Middle Tennessee Rural Reentry (MTRR) Program

This study evaluates the Middle Tennessee Rural Reentry (MTRR) program. MTRR is a rural reentry program funded by the Bureau of Justice Assistance that uses non-clinical case managers. Specifically, the program provided non-clinical case management and services to 144 medium and high-risk offenders released from a rural county correctional facility for up to 12 months after incarceration. Fully 56.9% of offenders completed the program, with 52.8% recidivating (i.e., arrest and revocation of supervision). Program completion did not have a statistically significant impact on recidivism. Moreover, females who participated in the program had a significantly lower overall likelihood of recidivism than when compared to male participants. Additional findings and policy implications for rural jail programs are also discussed.

Access to Healthcare Among Young Adult Probationers Participating in a Pilot Health-Focused Reentry Program.

Justice-involved adults experience disparities in healthcare access. This pilot study examines healthcare access among young adult probationers (n = 66) receiving 6-months of Service Navigation and Health Coaching support implemented between 2017 and 2021. Data are from baseline, 6-month follow-up and satisfaction surveys. Between baseline and follow-up, the proportion of insured young adult participants (66%-88%; p < .001) and those using healthcare services (36%-71%; p < .001) increased significantly; report of unmet physical healthcare needs decreased significantly (44%-26%; p = .003). Satisfaction data revealed increased self-efficacy, motivation, focus, and improved organizational, goal setting, and communication skills. The program improved healthcare access by increasing health insurance and recent use of healthcare services. Longitudinal studies are needed to assess maintenance of these outcomes and potential impacts on disparities in health status and access to care indicators. Integrating navigation and coaching supports to advance the well-being of justice-involved young adults is a promising mechanism to facilitate healthcare access.

BeHERE’s effective virtual training to build capacity to support people who use drugs in non-substance use disorder settings

BackgroundHuman service settings not specifically focused on supporting people who use drugs (PWUD), especially those with a substance use disorder (SUD), such as probation and parole services, homeless shelters, and work re-entry and job training programs, offer a unique opportunity to assist this population and prevent overdose deaths. During the COVID-19 pandemic (pandemic), building capacity in such settings for overdose prevention, harm reduction, and to address barriers to treatment, recovery, and support services required that training vendors use a virtual format. Post-pandemic, virtual training remains a cost-effective and convenient alternative to in-person training. The Behavioral Health and Racial Equity (BeHERE) Training Initiative of Health Resources in Action, which offers eight training modules on prevention, recovery, and harm reduction, delivered 224 online trainings between April 2020 and June 2022.MethodsA mixed methods evaluation based upon the Kirkpatrick Training Evaluation Model was employed, which utilized post-training (n = 1272) and follow-up surveys (n = 62), and key informant interviews (n = 35).ResultsThe findings showed BeHERE’s trainings were relevant, engaging, and satisfying to trainees; increased their knowledge, skills, and confidence; and influenced workplace performance. Some participants also indicated that the training influenced the effectiveness of their work with clients and other staff.ConclusionsThe evaluation identified aspects of training that make a virtual format effective at improving the capacity of non-SUD settings to address substance use and support PWUD. Findings offer insights for those interested in delivery of virtual training, as well as training to influence the practice of human service providers across different settings to support PWUD.

Towards a Retributive Concept of Re-entry

Abstract Retributive justice is the preferred penal theory in many countries, especially for serious offences, and is a predominant justification for imprisonment. Retributivists, however, have little to say regarding the state’s role towards returning citizens after release from prison. In reality, paroled individuals struggle with continuing surveillance, poverty, stigma and other significant barriers to housing, employment and health. Thus, rates of recidivism are high. Re-entry services can help, but they are few. Without a proper understanding of the implications of the retributive model, advocates for re-entry services struggle to gain public support or the attention of policy-makers. Recognising that retributivism is not a monolithic theory, and with a focus on the parole period, we argue that key sub-streams of retributivism offer a valuable support for understanding public responsibility for re-entry services. To that end, we offer a conceptual understanding of the core retributive principles that call upon governments to actively assist parolees. We do so by connecting re-entry to the retributive notions of unfair advantage, penal communication and moral reform. Finally, we emphasise two, often neglected, re-entry programmes that fit the core retributive principles and highlight implications for the parole process.

“That Shit Ain’t Helping Nobody”: Narratives of Exclusion and Individualism Among Criminalized Men

ABSTRACT Reentry efforts tend to focus on individual-level factors in an attempt to transform formerly incarcerated people into law-abiding, productive, and responsible citizens. Unfortunately, evaluative research provides mixed results on the efficacy of reentry programming and ample research suggests the need to better address structural barriers to (re)integration. Less is known about how formerly incarcerated people conceptualize reentry fields. Drawing on fieldwork and interviews with 49 formerly incarcerated men, this article helps to fill such gaps. As they discussed their reentry-related experiences and aspirations, we find that interviewees embraced a particular brand of individualism – what we refer to as criminalized individualism – that reflects not only institutional scripts around responsibility, but experiences of exclusion as well. The formerly incarcerated men in this study felt isolated from decent jobs, fair societal treatment, and tangible support beyond the admonition that personal responsibility would be required to succeed. In response, they expressed a broad-based cynicism of the Prisoner Reentry Industry (PRI), and espoused inward-looking strategies for social mobility. We argue that the perspectives of formerly incarcerated people are integral for understanding the function of reentry systems today and that the individual-level focus on responsibility largely ignores the structural realities of carceral citizenship.

Qualitative Analysis of School Re-Entry Experiences of Turkish Survivors of Childhood and Adolescent Cancer: Parental Perspective

This study aimed to explore the school re-entry experiences of Turkish survivors of childhood and adolescent cancer. In this qualitative study, semistructured in-depth interviews were undertaken with parents of childhood cancer survivors who had completed treatment for at least 2 years (n = 20). Interviews were conducted via telephone or video conferencing. The study was conducted and reported according to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines. The components of qualitative rigor were considered to ensure confidence in the methods and data. The average age of parents was 43.20 ± 4.66 years (range 37-55) (n = 20). The mean age of survivors was 8.45 ± 2.03 years at diagnosis and 15.05 ± 2.08 years during the study. The diagnosis of most of the survivors was lymphoma (35%). Four main themes were developed: worry; challenging situations; negative effects of the disease process; and facilitating situations. Parents stated that both children and parents need support during the school re-entry process. This study revealed that survivors may experience problems that make school re-entry difficult. With cooperation between the health team and the school, arrangements should be made to ensure survivors have a positive experience on school re-entry. Pediatric oncology nurses should know survivors' requirements and take action to deliver school re-entry adjustment programs.

Successful return to work in anaesthesia after maternity leave: a qualitative study.

Returning to work after maternity leave poses significant challenges, with potential long-term implications including decreased engagement or attrition of clinicians. Many quantitative studies have identified challenges and supports for women during pregnancy, maternity leave and re-entry to clinical practice. This qualitative study explored the experiences of anaesthetists returning to clinical work after maternity leave, to identify influential factors with the aim of providing a framework to assist planning re-entry. We conducted semi-structured interviews with 15 anaesthetists. Attendees of a re-entry programme were invited to participate, with purposive sampling and snowball recruitment to provide diversity of location and training stage, until data saturation was reached at 13 interviews. Five themes were identified: leave duration; planning re-entry; workplace culture; career impact and emotional impact. Leave duration was influenced by concerns about deskilling, but shorter periods of leave had logistical challenges, including fatigue. Most participants started planning to return to work with few or no formal processes in the workplace. Workplace culture, including support for breastfeeding, was identified as valuable, but variable. Participants also experienced negative attitudes on re-entry, including difficulty accessing permanent work, with potential career impacts. Many participants identified changes to professional and personal identity influencing the experience with emotional sequelae. This research describes factors which may be considered to assist clinicians returning to work after maternity leave and identifies challenges, including negative attitudes, which may pose significant barriers to women practising in anaesthesia and may contribute to lack of female leadership in some workplaces.

Passport to Freedom: A Trauma-Informed Mindfulness Program for Previously Incarcerated Women.

Poly-victimization is often reported by formerly incarcerated women and leads to physical and mental health problems that interfere with daily functioning, sustained employment, and housing stability. Although reentry programs exist, few focus on the physical and emotional impact of multiple traumas. Passport to Freedom (P2F), a woman-centered, trauma-informed reentry program, was developed to support formerly incarcerated women. The pilot intervention, performed in 2017, focused on the connections between trauma and health, coping with symptoms, and managing one's own health. To examine the effectiveness and feasibility of the intervention, we performed the current mixed methods study with two phases: (1) focus groups, and (2) sessions combining mindfulness and health promotion activities with follow-up evaluations. Participants (N = 24) showed decreased symptoms of depression and concerns of everyday stressors after the intervention. Of participants, 84% (n = 16) reported practicing mindfulness and 63% (n = 8) stated that mindfulness exercises helped with daily stress management. The P2F program offers a promising approach to support formerly incarcerated women with health self-management. [Journal of Psychosocial Nursing and Mental Health Services, 62(6), 18-26.].

Health and Care Needs of Young Adults Exiting Jail.

Reentry is a difficult juncture for young adults (ages 18-24 years), who simultaneously face challenges of emerging adulthood. Although their health-related needs may be substantial, little is reported on young adults' reentry health care and social service needs. Furthermore, empirical measurements of factors affecting their engagement in reentry services after jail are lacking. We sought to describe health needs and predictors of linkages to reentry services for the 2,525 young adult participants in the Whole Person Care-LA Reentry program (WPC Reentry). Descriptive statistics were calculated and chi-square tests, t tests, and logistic regression were performed to identify factors associated with linkage to WPC Reentry postrelease compared with only engaging with WPC Reentry prerelease. Most participants (72.6%) were male, 80.2% were Hispanic or Black, and 60.9% had been unhoused. Mental health (57.2%) and substance use disorders (45.8%) were common, physical health was overall good (mean Charlson Comorbidity Index score 0.53), and social needs, especially housing, were high (40.7%). Older age (i.e., closer to 25 years) and history of being unhoused were associated with higher postrelease engagement in WPC Reentry (age: odds ratio [OR] = 1.06, p = .01; history of being unhoused: OR = 1.18, p = .05). Attentiveness to younger clients and to addressing housing needs may be key for successful reentry care linkages.