A robust public health response is necessary across the spectrum of locations providing housing, healthcare, and other services to people with criminal-legal involvement. Our study is the first to use implementation science methods to guide the process of evaluating COVID-19 testing in re-entry sites. Overall, re-entry sites have been overlooked as important opportunities for providing COVID-19 related care. There is one publication about COVID-19 in re-entry sites in contrast to over 600 independent articles about COVID-19 in jails and prisons.35 The lack of research reflects a significant gap in the attention and care towards the transitionary period between incarceration and the period of re-entry.
People who live in post-incarceration residences fall in a gray zone as it relates to health care. The healthcare barriers people face on re-entry have been well chronicled by several clinicians, researchers, and advocates. For instance, the Transitions Clinic Network (TCN), a growing network of 30 community health centers nationwide providing healthcare to individuals recently released from incarceration by employing individuals with a history of incarceration as community health workers, was created to alleviate the health care problems facing people on re-entry.36 The TCN focuses on social needs, such as housing, food insecurity, and criminal legal system contact, along with patients’ medical needs.37
During physical detention in jails and prisons, most aspects of life, including access to health services, are highly regulated. If people are released into the community and not living in a residential program, there can be challenges transitioning back into the community, including but not limited to finding employment, transportation, activating health insurance, childcare, and housing. Moreover, these challenges are exacerbated by one of the long term-effects of incarceration, learned helplessness. One study found that inmates who had been incarcerated for more than five years had a more pessimistic explanatory style for negative events than inmates who had been incarcerated for less than five years.38 This finding suggests that individuals’ experiences having their health issues ignored while incarcerated may impact their ability to prioritize their health issues post-incarceration.38 Although re-entry site programs assist with the housing aspect, there are still considerable restrictions on when residents are allowed to leave because of required programming and curfews. During the period of incarceration, there is no question that COVID-19 testing needs to be organized through the jail or prison. When living in a residence on community supervision, however, it is less clear where the responsibility lies for making testing accessible.
Most survey respondents agreed that the implementation of rapid COVID-19 testing at re-entry sites was acceptable, feasible, and appropriate. The operationalization of COVID-19 tests varied across sites. Not all the sites provided testing to the residents. Based on survey results, there was differential levels of awareness of COVID-19 testing availability for residents and staff (Figure IV). Notably, most employees from Site 8 and Site 9 were aware of the availability of COVID-19 testing at their workplace, suggesting that these two sites implemented the testing, although little to no test results were recorded. We learned that there were challenges in communicating changes in policies to employees, especially during a time that policies were dynamic. These findings highlight the need for community supervision programs to prioritize finding effective ways to disseminate important information related to COVID-19 testing to their employees and residents.
One of the limitations of our study is that it may not be generalizable to re-entry sites in different geographical areas. Our study focused on testing sites on the East coast and the barriers to implementing testing in re-entry programs may vary by location. Additionally, our project was made feasible through funding by the NIH. Replication of this study may be difficult without funding. Lastly, getting BOP approval may be a barrier to replicating this study. The research team encountered obstacles in obtaining approval to test residents at BOP sites, which delayed the use of rapid testing for residents for several months after the initiation of the pilot project.
Nearly three years into the COVID-19 pandemic, there are still important lessons to learn about COVID-19 mitigation. Although there have been strides towards health equity, access to COVID-19 testing, vaccines, and treatment is still not equitable. As future variants of COVID-19 emerge, and with the high likelihood of new pandemics on the horizon, people who work and live in re-entry sites should not be forgotten. We suggest that re-entry sites plan for future infectious disease pandemics by consulting with public health and infectious diseases specialists to develop pandemic protocols and policies.