Date Published: April 2, 2019
Publisher: BioMed Central
Author(s): Katherine Thomas, John L. Wilson, Precious Bedell, Diane S. Morse.
Women recently released from incarceration have increased rates of co-occurring substance use, physical health, and mental health disorders. During re-entry, they face challenges navigating needed health services and social services stemming from these problems. Women’s Initiative Supporting Health Transitions Clinic (WISH-TC) is a primary care program that facilitates treatment access for re-entering women. Strategies include support and navigation assistance from peer community health workers.
Thirteen participants, of whom 11 had a substance use disorder, completed semi-structured interviews about their experiences in WISH-TC as part of a process evaluation. We conducted a qualitative framework analysis informed by self-determination theory.
WISH-TC supported autonomy as staff helped motivate women to work toward personal health goals. Women were empowered to have their health needs met, and consequently, prioritized attending clinic. Regarding competence, WISH-TC built upon women’s existing knowledge to increase their health literacy and better understand their individual health needs. Relatedness support, both prior to re-entry and ongoing with clinic staff, was key in women’s satisfaction with their care. The clinic made procedural changes in response to the interviews, including providing orientation for the patients and training the clinic in trauma-informed practices.
Our findings highlight the potential of a program for re-entering women, including those with substance use disorders to strengthen their abilities to navigate complex healthcare and societal systems. WISH-TC helped women feel supported, motivated, and competent to address their substance use, physical, and mental health conditions.
As of 2018, over 2.3 million adults comprise jail and prison populations in the United States . While men represent the majority, women are the fastest growing incarcerated cohort, increasing 646% from 1980 to 2010, 50 percent higher than the rate of men [2, 3]. In 2016, nearly 1.2 million women had correctional involvement including probation, parole, and in correctional facilities . Race and ethnicity were important in incarceration; as reported in 2016, for every 100,000 women in the US, 49 Caucasian, 67 Hispanic, and 96 African-American women were incarcerated . As individuals re-entered their communities, many faced challenges navigating complex social services, obtaining Medicaid coverage , and accessing substance use disorder (SUD) and primary care treatment [6–9]. Few programs have holistically addressed these concerns. This study describes patient’s experiences of treatment in a specialized medical clinic for women re-entering from incarceration that utilized motivational and trauma-specific approaches.
These medically and socially complex women generally viewed the specialized clinic strategies positively, which has implications for others caring for similar patients. Previous studies have shown that SDT strategies are effective in addressing a variety of health risk behaviors, and we found that this model was appropriate for use with women in re-entry [47–51]. Regarding autonomy, staff presenting WISH-TC to women while incarcerated helped empower them to make the decision to seek healthcare upon release and get their needs met quickly, despite system barriers. Women noted how autonomy support from various clinic staff helped them to develop motivation and navigation skills and work towards personal goals such as quitting smoking and maintaining sobriety. Women prioritized coming to the clinic, despite system challenges, as they saw the services as essential for their recovery. Women developed competence in terms of building upon their existing health literacy, learning about community resources through CHWs, and gaining a better understanding of their personal health needs through interactions with the physician and other clinic staff. Program staff reached out to contact participants prior to release from incarceration as well as in community locations to provide assistance in scheduling clinic appointments, which facilitated women’s navigation competence. Relatedness contributed significantly to women’s satisfaction with WISH-TC. All noted experiences of relatedness support with their physician and CHW that made them feel comfortable and understood at the clinic. Staff were viewed as nonjudgmental and supportive to women entering SUD treatment. Women noted that staff’s knowledge of their personal history made them feel comfortable discussing trauma and communicating openly about their concerns. The sum of this feedback supports the utility of the program and gives indications of what is helpful and what is not.
Re-entering women face challenges to accessing quality medical care that meets their needs. WISH-TC’s integrative design and staff’s understanding of the unique needs of this population have helped women feel supported, motivated, and competent to address their substance use, physical, and mental health needs. It is worth further exploring ways to improve health literacy in this population, as well as dynamics between peer CHWs and patients. While this study informed our clinic practices, we believe it can also inform others working clinically and using research to meet complex needs of justice-involved women, especially other programs using a peer-to-peer model with re-entry CHWs. Our study models for other agencies serving justice involved women how integral nonjudgmental staff, trauma-informed care, and minimizing systemic barriers to access care are to women’s engagement in treatment.