Enhancing community integration after incarceration: findings from a prospective study of an intensive peer support intervention for veterans with an historical comparison group

Abstract

Background The transition to the community after incarceration presents challenges for returning citizens, including the immediate need to secure housing, employment, and income. Additionally, health care is essential for this population due to high rates of chronic physical health and mental health problems and substance use disorders. There is growing recognition of the need for interventions that support returning citizens as they navigate community reintegration while simultaneously tending to physical and behavioral health needs. We developed and pilot tested a peer support intervention designed to provide social, emotional, and logistic support and promote linkage and engagement in healthcare for returning citizens. We tested the intervention with US military veterans in Massachusetts who were being released from prison and jail. Outcomes related to linkage to and engagement in healthcare were evaluated using an historical comparison group. Engagement in peer support, housing status, and reincarceration rates were monitored for the intervention group. Results There were 43 veterans in the intervention group, and 36 in the historical comparison group. For linkage to primary care within 90 days of release, there were no statistically significant differences between the intervention and comparison groups (58% versus 67%). Intervention participants were significantly more likely to receive substance use treatment than the comparison group (86% versus 19%, p < .0001) and the mean monthly substance use visits was greater in the intervention group (0.96 versus 0.34, p < .007). Engagement in mental health services was greater for the intervention group than the comparison group (93% versus 64%, p < .003). There were no significant differences between groups for emergency department use and hospitalization. At the end of the study period, the majority of intervention participants who had been released for over a year were living in permanent housing (84%). Recidivism among the was low, with 7% re-arrested during the study period. Conclusions Augmenting reentry support through intensive peer support appears to have substantial benefits for veterans in terms of engaging them in health care and contributing to their longer-term stability, including housing and recidivism. Flexible reentry support such as this intervention may be well suited to meet the widely varying needs of returning citizens.

Identifying structural risk factors for overdose following incarceration: a concept mapping study

“…Increasing access to basic needs such as housing, employment, and medical care, as well as being surrounding by a supportive and understanding community or having a relationship with a peer, have been shown in several studies to increase linkage to care, mobilize communities to advocate for systemic change, and prevent disease to create healthier populations ( A Compendium of Proven Community-Based Prevention Programs , 2013; Chutuape et al, 2010 ; McLeod et al, 2020 ). Additionally, providing access to harm reduction programs, peers, and supplies (i.e., Narcan, testing strips), can decrease negative health outcomes such as overdose and disease transmission, bridge the gap for other essential services such as housing and health care, and can be a patient-centered and individualized approach to increase linkage to health care and decrease recidivism (Ashford et al, 2018 ; Barocas et al, 2015 ; Hunter et al, 2016 ; Hyde et al, 2022 ; Khan et al, 2022 ).…”

“Shared experience makes this all possible”: documenting the guiding principles of peer-led services for people released from prison

“…Prior studies of peer-led programs have identified that once program expansion occurs to more standardized organizational environments, the guiding principles and values of peer-led organizations can become more and more difficult to maintain [ 49 ]. This does not preclude health and justice systems from establishing or expanding peer-led services or incorporating peer experiential workers into existing programs, as there are undoubtedly benefits in these models, as demonstrated by prior studies [ 4 ]. This does however highlight a gap filled by UTGSS, who provide a peer-led service, where the direction of service provision remains independent of the directives of health and justice organizations.…”

“…People who have been incarcerated face a number of barriers transitioning from prison back to community [ 1 – 3 ]. These are driven in part by the significant interruptions to community, health system, family, and peer networks of support posed by periods of incarceration [ 3 , 4 ]. Upon return to community, the most immediate needs facing this population are income and social support to obtain basic needs, including access to food, clothing, and safe and stable housing [ 5 , 6 ].…”

“…For example, a pilot randomized controlled trial in the United States tested a peer-led support intervention which provided social, emotional, and logistical support to people released from prison to promote health care engagement. People who received the intervention were significantly more likely to access substance use treatment and mental health services, to live in permanent housing, and had a lower recidivism rate than people who did not have access to the peer support services [ 4 ]. The evidence supporting these programs builds on decades of evidence from peer-led services in other settings, for example, among people living with HIV, people who use substances and access harm reduction services, and people with chronic diseases such as diabetes, whereby peer support builds a sense of trust which can support readiness to engage in services [ 20 – 24 ].…”

Medicaid Inmate Exclusion Policy and Infectious Diseases Care for Justice-Involved Populations

“…Most persons incarcerated in the United States spend short periods (<30 days) in jail ( 27 ) and often cycle multiple times from jail to community, further fragmenting needed care. People leaving jail and prison face barriers getting Medicaid reactivated, making appointments, and getting medications ( 28 , 29 ). Another barrier, with its own set of challenges, is data sharing between correctional and community healthcare systems ( 30 ).…”