A novel application of process mapping in a criminal justice setting to examine implementation of peer support for veterans leaving incarceration

Abstract

Background Between 12,000 and 16,000 veterans leave incarceration every year, yet resources are limited for reentry support that helps veterans remain connected to VA and community health care and services after leaving incarceration. Homelessness and criminal justice recidivism may result when such follow-up and support are lacking. In order to determine where gaps exist in current reentry support efforts, we developed a novel methodological adaptation of process mapping (a visualization technique being increasingly used in health care to identify gaps in services and linkages) in the context of a larger implementation study of a peer-support intervention to link veterans to health-related services after incarceration ( https://clinicaltrials.gov/ , NCT02964897, registered November 4, 2016) to support their reentry into the community. Methods We employed process mapping to analyze qualitative interviews with staff from organizations providing reentry support. Interview data were used to generate process maps specifying the sequence of events and the multiple parties that connect veterans to post-incarceration services. Process maps were then analyzed for uncertainties, gaps, and bottlenecks. Results We found that reentry programs lack systematic means of identifying soon-to-be released veterans who may become their clients; veterans in prisons/jails, and recently released, lack information about reentry supports and how to access them; and veterans’ whereabouts between their release and their health care appointments are often unknown to reentry and health care teams. These system-level shortcomings informed our intervention development and implementation planning of peer-support services for veterans’ reentry. Conclusions Systematic information sharing that is inherent to process mapping makes more transparent the research needed, helping to engage participants and operational partners who are critical for successful implementation of interventions to improve reentry support for veterans leaving incarceration. Even beyond our immediate study, process mapping based on qualitative interview data enables visualization of data that is useful for 1) verifying the research team’s interpretation of interviewee’s accounts, 2) specifying the events that occur within processes that the implementation is targeting (identifying knowledge gaps and inefficiencies), and 3) articulating and tracking the pre- to post-implementation changes clearly to support dissemination of evidence-based health care practices for justice-involved populations. Electronic supplementary material The online version of this article (10.1186/s40352-019-0085-x) contains supplementary material, which is available to authorized users.

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“…Finally, the developed process map provided explicit visualisation of the referral process which was further analysed in two steps. First, we examined the uncertainties in the sequence of steps within the process and/or lack of systematised steps, gaps [that is, discrepancies of what the process is intended to be and what is actually is], bottlenecks within the process that cause delays before the next step occurs and ine ciencies [unnecessarily repeated steps leading to delays] to uncover potential areas for improvement broadly similar to approach used by (28). Key themes and sub themes were also discussed by the ve researches [BO, DO, MN, KAP, TB].…”

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Implementation Science to Respond to the COVID-19 Pandemic

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