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Helping ex-prisoners keep out of prison: what works

What helps ex-offenders avoid rearrest? Stephen Lam/Reuters

Helping ex-prisoners keep out of prison: what works

What helps ex-offenders avoid rearrest? Stephen Lam/Reuters

In California, about 74 percent of people who leave prison return within 12 months. Considering that the California prison system paroles about 45,000 people each year, this recidivism rate presents serious problems for policymakers and correctional agency administrators. It’s a revolving door – one that needs to be stopped.

Transitioning back into society presents real challenges for male offenders. During their time in prison or jail, they often lose contact with their families and support networks, creating insurmountable odds for successful reentry into the community. On top of that, these men often have limited access to health care, housing, education and employment, disadvantages that can lead to homelessness and rearrest.

With the deck stacked against parolees in so many ways, my colleagues and I wondered what sort of interventions could help keep them from returning to the life that put them in prison in the first place.

Five years ago, with a grant from the National Institute on Drug Abuse, my colleagues and I enrolled 600 men who were recently released from prison or jail and were currently residents at the Amistad de Los Angeles residential drug treatment program in a study. All of the parolees had been homeless prior to being incarcerated, which places them at risk for rearrest.

We wanted to assess what sort of post-release coaching and health assistance program would help them with stay healthy and and avoid the kinds of behavior that could lead to rearrest.

Preventing parolees from falling into old habits

We divided the 600 parolees into three groups. One group received both intensive peer coaching and case management. The second group received intensive peer coaching but only brief counseling from nurses about hepatitis and the hepatitis vaccine. The third group received limited peer coaching and an even shorter session about hepatitis and the vaccine.

We found that each combination helped to reduce drug use and risky sexual activity and to lower recidivism rate. We also found that the third group, the model with limited peer coaching and support from nurses, was the most cost-efficient and just as effective as the other two, more intensive models.

Within 12 months of release, 62.1 percent of parolees in our study were rearrested. That might seem high, but keep in mind that one-year reincarceration rate for all California parolees in 2013 was 74.1 percent. So parolees who went through any of the three combinations of nursing care and peer coaching were less likely to be back in prison one year after release.

We also found that 12 months after starting the study, parolees reported using fewer drugs and engaging in fewer risky sexual activities than they had before being incarcerated.

That all three variations succeeded in lowering the rearrest rate, and in reducing drug use and risky behaviors, suggests that there is something beneficial about combining nurse case management with peer coaching.

Nurses provide critical health assistance

Nurses believe that improving one part of your life can have ramifications in lots of other parts. For example, seeking a healthier lifestyle can lead one to become motivated to seek job skills or employment and end the cycle of drug use and reincarceration. In this study, the nurse case manager performed health assessments, and provided health education regarding the dangers of injecting drugs and having unprotected sex.

Parolees, and particularly those with a history of homelessness, are at high risk for hepatitis B and C virus and HIV. We tested all participants for hepatitis B virus, which is vaccine-preventable. If he tested positive, the nurse provided speedy access to vital health services and arranged appointments for further examinations and treatment. If the test was negative, eligible participants received the HBV vaccine, which protects against hepatitis A and B.

In our study 73 percent of participants completed the HBV vaccination series.

This vaccine completion rate, in particular, is important because only 12 percent of incarcerated populations complete the three-dose vaccine series.

Two-thirds of those arrested in the U.S. test positive for drugs and over half the men exiting jail and prison have sex on the first day of release. Risky sexual behavior is not an independent risk factor for rearrest, but it may be a sign that these parolees may be returning to old habits that got them in trouble in the first place

Other risky activities, such as ongoing drug use, are easily adopted by ex-offenders who have difficulty coping with life post-incarceration. This can often lead to criminal behavior – either while under the influence of drugs or to support their drug habit.

While nurses can provide critical support, parolees need more than that to cope with life after prison. That is where the peer coaches come in.

Peer coaches know the road that parolees are on

The peer coaches were all former inmates who were trained about the needs and challenges faced by parolees discharged to the community. As a role model who has served time in prison and successfully transitioned back into the community, the peer coach makes a powerful difference for parolees. They know what it’s like to be released from prison and to try and start over. In fact, several of the peer coaches had actually been treated at the residential treatment facility where our study was based. The parolees were also impressed by the fact the peer coaches were employed on federally funded grant through a prestigious university.

The coaches went through several weeks of training covering the research process, ethical conduct, social justice, organizational skills, coping behaviors and information about hepatitis. Most importantly, the peer coaches learned about the resources available in the community to help parolees.

We found that peer coaches had a real ear for listening and a talent for providing advice to parolees on how to cope with life after incarceration. Peer coaches guided recently released ex-offenders in direct pathways to seeking jobs. They warned against returning to old neighborhoods and old friends who might still be using drugs and involved in gang activity. Most importantly, they reminded the ex-offenders to seek advice and support when in need.

They also reminded parolees to receive all three doses of the HBV vaccine, reinforcing what the nurses in the program had told them.

Where do we go from here?

Our research suggests that support for residential treatment facilities along with peer coaching and nurse-partnered care can result in long-term success of community reentry.

While the original study focused on male offenders, we found there was a real interest from women parolees and probationers to be part of the study. Therefore, we are currently conducting a three-year study of women parolees.