Formerly Incarcerated Community Health Workers Engaging Individuals Returning From Incarceration Into Primary Care: Results From the Transition Clinic Network

Abstract

Over half a million individuals return from United States prisons and millions more from jails every year, many of whom with complex health and social needs. Community health workers (CHWs) perform diverse roles to improve health outcomes in disadvantaged communities, but no studies have assessed their role as integrated members of a primary care team serving individuals returning from incarceration. Using data from participants who received primary care through the Transitions Clinic Network, a model of care that integrates CHWs with a lived experienced of incarceration into primary care teams, we characterized how CHWs address participant health and social needs during interactions outside of clinic visits for 6 months after participants established primary care. Among the 751 participants, 79% had one or more CHW interactions outside of the clinic documented. Participants with more comorbid conditions, longer stays during their most recent incarceration, and released with a prescription had more interactions with CHWs compared to those with fewer comorbidities, shorter stays, and no prescription at release. Median number of interactions was 4 (interquartile range, IQR 2–8) and 56% were in person. The most common issues addressed (34%) were social determinants of health, with the most common being housing (35%). CHWs working in interdisciplinary primary care teams caring for people with histories of incarceration perform a variety of functions for clients outside of scheduled primary care visits. To improve health outcomes among disadvantaged populations, CHWs should be able to work across multiple systems, with supervision and support for CHW activities both in the primary care clinic and within the community.

Peer Workers in Co-production and Co-creation in Mental Health and Substance Use Services: A Scoping Review

“…The last two studies are from the US. The study by Aminawung et al ( 2021 ) described how community health workers with histories of incarceration were integrated as care team members and supported patients during clinic visits aside from providing essential input on the design of programs and services and advocating for changes in clinic policies and practices. The study by Myers et al ( 2021 ) described Emotional CPR (eCPR), a program developed and delivered by individuals with a lived recovery experience from trauma and mental health challenges and that aimed to train community members in supporting others through mental health crises.…”

“…The other studies that described peer workers as partners in co-creation focused on implementation, identification of challenges and opportunities, and how collaborative practices involving peer workers unfolded. One study examined peer qualities and peer workers’ roles as integrated members of a primary care team serving individuals returning from incarceration (Aminawung et al, 2021 ).…”

“…Commonly, the studies described peer workers as bridges (Burke et al, 2018 ; Byrne et al, 2018 ; Cleary et al, 2018 ; Hillman et al, 2022 ; MacLellan et al, 2017 ) and individuals who facilitate connecting (Clossey et al, 2018 ; Harris et al, 2020 ; Van Zanden & Bliokas, 2021 ; Weir et al, 2019 ; Zeng & Chung, 2019 ), linking (Byrne et al, 2021b ; Jacobson et al, 2012 ; Martin et al, 2021 ; Otte et al, 2019 ; Scanlan et al, 2017 ), and navigating (Aminawung et al, 2021 ; Barrenger & Hamovitch, 2019 ; Brasier et al, 2022 ; Chisholm & Petrakis, 2020 ; Corrigan et al, 2017 ) and who function as advocates (Byrne et al, 2017 ; Ehrlich et al, 2020 ; Eisen et al, 2015 ; Scanlan et al, 2020 ; Wyder et al, 2020 ). Consequently, peer workers expand service users’ access to resources and increase their involvement with the service system.…”

“…Furthermore, research confirms that peer workers’ roles and responsibilities may also benefit the individuals in these positions (Agrawal et al, 2016 ; Barrenger et al, 2020 ; Debyser et al, 2018 ; Jo & Nabatchi, 2021 ; Moran et al, 2012 ) by increasing their competence and self-efficacy. However, peer workers’ involvement is usually described as a means to provide personal value and benefits to service users (Bocking et al, 2018 ; Castellanos et al, 2018 ; Cleary et al, 2018 ; Kidd et al, 2021 ), while their activities also are considered to have positive impacts on reducing societal problems and tackling social needs (Aminawung et al, 2021 ; Jones & Pietilä, 2020 ; Nelson et al, 2016 ; Tookey et al, 2018 ). When peer workers help reduce societal problems and have instrumental value for organizations in improving efficiency and effectiveness, they create broader public value (Torfing et al, 2020a ).…”

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

“…Community health workers provide an array of education, advocacy, and systems navigation services that can lessen the common barriers experienced by the justice-involved population. Aminawung al. (2021) found that over a third of formerly incarcerated patients who met with a community health worker during the reentry period received assistance with social determinants of health such as housing, health insurance, transportation, and government benefits, addressing the basic needs highlighted by the medical and legal participants in the current study.…”