Date Presented 4/19/2018Abstract Synopsis Occupation-based, holistic reentry programming is critical for the successful transition to the community of incarcerated individuals. This study explored the fidelity of prerelease occupational therapy services using a mixed methods process evaluation to identify the barriers and facilitators of implementation of justice-based occupational therapy.
Primary Author and Speaker: Lisa Jaegers
Additional Authors and Speakers: Christine Hayes
Contributing Authors: Brittany Conners, William Meirink, Stacy West-Bruce, Anna Paskvalich, Serena Blank, Karen Barney
PURPOSE: Ninety-five percent of incarcerated individuals are eventually released to return to communities throughout the United States. Occupation-based programming supports healthy roles, habits, routines, and activities that encourage meaningful use of time for incarcerated people and promotes the development of skills that can decrease reoffense (Eggers et al., 2006). Occupational therapy programs addressing collaborative, holistic reentry services within justice settings and after transition are rare, and the literature describing their formation and efficacy is scarce.
Process evaluation is a method used in the formative stage of program development to determine fidelity, which is the extent to which a program was implemented as it was intended (Linnan & Steckler, 2002). Process evaluation provides iterative feedback to enable continuous improvement in services and is necessary to inform the interpretation of a related intervention efficacy study. The purpose of this study was to describe program fidelity and explore barriers and facilitators in implementing prerelease occupational therapy services in an urban jail using ecological-level descriptors.
METHOD: The Saint Louis University reentry team led by occupational therapy practitioners piloted a collaborative pre- and postrelease program in an urban Midwestern jail. This study focused on the mixed methods process evaluation of prerelease group training sessions that occurred in 2017 with our first cohort of participants. Eight weeks of sessions consisted of reentry training topics, interactive discussions, applied activities, and assigned homework.
Using session logs, the lead occupational therapist documented planned session metrics and recorded actual attendance, number released from jail, session start and end time, and level of participation. Session and team meeting notes described barriers and facilitators in carrying out each session. Logs were analyzed using descriptive statistics, and qualitative analysis of notes was performed in Atlas.ti (Berlin, Germany) using ecological levels of barrier and facilitator codebook constructs. Two coders performed thematic analysis using consensus methods.
RESULTS: Of our first cohort (N = 7), three participants were released during the first 2 wk of the program, two did not receive the full intervention and continued with the second cohort, and two completed the prerelease program and will transition to community-based occupational therapy on release. We delivered the intended training content in 26 sessions each averaging 2 hr. One-third of sessions began on time, average session attendance was 68%, and only 27% of sessions included all participants. Average completion of assigned homework was 93%.
Preliminary qualitative findings indicate that barriers to attendance involved challenges at the justice system level (e.g., unknown sentencing), organizational and management level (e.g., facility infrastructure, policies), and participant level (e.g., behavior violations). Facilitators included jail management and correctional staff support and highly motivated occupational therapy practitioners willing to adjust and problem solve in a challenging system. Aspects of the program over which the occupational therapy practitioners or participants had primary control showed greater fidelity than those affected by system or organizational procedures. Process measures from our second cohort (N = 10) will be combined with this data set for further study.
CONCLUSION: Occupation-based programming in justice systems is needed, and there is a lack of intervention research to inform occupational therapy reentry practice. This study identified gaps in the fidelity of our prerelease program attributed in part to system-, organization-, and individual-level barriers to participation. Further study is needed to inform program development and implementation to increase the potential for a positive impact on reentry outcomes.
IMPACT STATEMENT: The study findings contribute important information for occupational therapy practice to inform reentry program development and process evaluation methods for gaining iterative feedback on service delivery.
References
Eggers, M., Muñoz, J. P., Sciulli, J., & Crist, P. A. (2006). The community reintegration project: Occupational therapy at work in a county jail. Occupational Therapy in Health Care, 20(1), 17–37. https://doi.org/10.1080/J003v20n01_02
Linnan, L., & Steckler, A. (2002). Process evaluation for public health interventions and research: An overview. In A. Steckler & L. Linnan (Eds.), Process evaluation for public health interventions and research (pp. 1–24). San Francisco: Jossey-Bass.
