445 - Facilitators and barriers to engaging in reentry care for transition-aged young adults at an urban reentry clinic for justice-involved individuals
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 445 Publication Number: 445.219
Matthew C. Holm, The Children's Hospital at Montefiore, Bronx, NY, United States; Isuree Katugampala, The Children's Hospital at Montefiore, Staten ISland, NY, United States; Jessica Haughton, Albert Einstein College of Medicine, La Mesa, CA, United States; Kevin Fiori, Albert Einstein College of Medicine, Bronx, NY, United States
Chief Resident - Social Pediatrics The Children's Hospital at Montefiore Bronx, New York, United States
Background: Justice-involved youth (JIY) are a large group with notable health disparities, including increased mortality compared with their peers, poor mental health, and problematic substance use. Transitions Clinics, which are a national network of clinics that address health disparities for individuals recently released from incarceration, involve a team of health care providers, community health workers with previous justice-involvement, and community partners focused on individuals recently released from incarceration. However, we have limited understanding of the JIY experience at these community reentry clinics. Objective: We sought to identify factors that influenced or discouraged participation of JIY at the Bronx Transitions Clinic, a clinic targeted for individuals recently released from incarceration. Design/Methods: We performed 11 in-depth semi-structured interviews informed by a socioecological framework (June 2021-April 2022) with individuals who sought care or others who contributed to the care of individuals at the Bronx Transitions Clinic, located in the South Bronx at an urban federally qualified health center. This framework was chosen due to presumed multilevel barriers faced by JIY. Those interviewed included clinic patients, case managers, community health workers, and training physicians. Interviews were audio-recorded, transcribed and analyzed by investigators for prevailing themes. Interviews were coded and analyzed utilizing an inductive, team-based approach. Results: Patients and stakeholders described experiences with significant structural violence and social need. They expressed need for substance use and mental health services, along with support to attain employment and housing upon release from incarceration, which at times stood in opposition to their ability to engage in reentry care. Other barriers to care included transportation, competing social needs, and stigma embedded within the healthcare system. Their care was often facilitated by community health workers of lived experience or providers aware of their experiences as previously incarcerated individuals. Study participants also noted improved retention in care for those with increased social and healthcare support systems, including reentry clinics.
Conclusion(s): Young people recently released from incarceration face significant marginalization and structural violence. Young people perceive their health, which may be affected by significant mental health and substance use concerns, as less of a priority than their social needs. This supports the design of targeted care models that consider the input of JIY.
