TY - JOUR
T1 - Structural competency in the post-prison period for people who inject drugs
T2 - A qualitative case study
AU - Treloar, Carla
AU - Schroeder, Sophia
AU - Lafferty, Lise
AU - Marshall, Alison
AU - Drysdale, Kerryn
AU - Higgs, Peter
AU - Baldry, Eileen
AU - Stoove, Mark
AU - Dietze, Paul
N1 - Funding Information:
Mark Stoove is the recipient of a NHMRC Senior Research Fellowship (Commonwealth Government) and has received investigator initiated funding from Gilead Sciences, AbbVie and Bristol Myers Squibb for research unrelated to this work.
Funding Information:
This research is supported under National Health and Medical Research Council Project grant ( APP1124368 ). SuperMIX was funded by the Colonial Foundation Trust and the NHMRC ( #545891, #1136908 ). The Burnet Institute is supported by the Victorian Operational Infrastructure Support Program.
Funding Information:
Carla Treloar has received speakers’ fees from Abbvie and Gilead and research funding from Merck for research unrelated to this work.
Publisher Copyright:
© 2021
PY - 2021/9
Y1 - 2021/9
N2 - Introduction: Access to services is key to successful community (re-)integration following release from prison. But many people experience disengagement from services, including people who inject drugs (PWID). We use a case study approach and the notion of structural competency to examine influences on access to services among a group of PWID recently released from prison. Methods: This qualitative study recruited participants from SuperMIX, (a longitudinal cohort study in Victoria, Australia). Inclusion criteria: aged 18+; lifetime history of injecting drug use; incarcerated for > three months and released from custody < 12 months previously. From 48 participants, five case studies were selected as emblematic of the complex and intersecting factors occurring at the time participants missed an appointment at a service. Results: Numerous, concurrent, and interdependent structural influences in participants’ lives coincided with their difficulty accessing and maintaining contact with services and resulted in missed appointments. The key factors involved in the cases presented here include policies around opioid agonist treatment, inadequate, unsuitable and unsafe housing, the management of mental health and side effects of treatment, the lack of social support or estrangement from family, and economic hardship. The support available from service workers to navigate these structural issues was inconsistent. One dissenting case is examined in which missing appointments is anticipated and accommodated. Conclusions: A case study approach enabled a holistic and in-depth examination of upstream structural elements that intersect with limited social and economic resources to exacerbate the challenges of community re-entry. These results highlight structural issues that have a disproportionate impact on the choices and opportunities for PWID. The incorporation of a structural competency framework in design of services and in staff training could support person-centred and coordinated service provision that take into account PWID's experiences post-release to overcome structural barriers to service engagement.
AB - Introduction: Access to services is key to successful community (re-)integration following release from prison. But many people experience disengagement from services, including people who inject drugs (PWID). We use a case study approach and the notion of structural competency to examine influences on access to services among a group of PWID recently released from prison. Methods: This qualitative study recruited participants from SuperMIX, (a longitudinal cohort study in Victoria, Australia). Inclusion criteria: aged 18+; lifetime history of injecting drug use; incarcerated for > three months and released from custody < 12 months previously. From 48 participants, five case studies were selected as emblematic of the complex and intersecting factors occurring at the time participants missed an appointment at a service. Results: Numerous, concurrent, and interdependent structural influences in participants’ lives coincided with their difficulty accessing and maintaining contact with services and resulted in missed appointments. The key factors involved in the cases presented here include policies around opioid agonist treatment, inadequate, unsuitable and unsafe housing, the management of mental health and side effects of treatment, the lack of social support or estrangement from family, and economic hardship. The support available from service workers to navigate these structural issues was inconsistent. One dissenting case is examined in which missing appointments is anticipated and accommodated. Conclusions: A case study approach enabled a holistic and in-depth examination of upstream structural elements that intersect with limited social and economic resources to exacerbate the challenges of community re-entry. These results highlight structural issues that have a disproportionate impact on the choices and opportunities for PWID. The incorporation of a structural competency framework in design of services and in staff training could support person-centred and coordinated service provision that take into account PWID's experiences post-release to overcome structural barriers to service engagement.
KW - People who inject drugs
KW - Prison release
KW - Qualitative case study
KW - Structural competency
UR - http://www.scopus.com/inward/record.url?scp=85105604867&partnerID=8YFLogxK
U2 - 10.1016/j.drugpo.2021.103261
DO - 10.1016/j.drugpo.2021.103261
M3 - Article
C2 - 33990057
AN - SCOPUS:85105604867
SN - 0955-3959
VL - 95
JO - International Journal of Drug Policy
JF - International Journal of Drug Policy
M1 - 103261
ER -
