UCSF

THE IMPACT OF HEALTH CARE ACCESS ON THE COMMUNITY REINTEGRATION OF MALE PAROLEES Elizabeth Marlow ABSTRACT Of the 784,400 individuals released from prison in 2005, most were likely to have not finished high school, have limited employment skills, represent ethnically diverse and marginalized communities, and have multiple health problems. These individuals often have long criminal histories and their time in the free world is punctuated by frequent reincarcerations. The purpose of this study was to understand how health care access affects the community reintegration of male parolees. The specific aims were to: examine the health beliefs and practices regarding general health care and specific medical conditions from the parolee's perspective; identify the perceived barriers and facilitators parolees encountered in accessing community health care services; describe the impact of health care access on reintegration from the parolee's perspective; and identify specific events in the parolee's life that may have affected his reintegration. Hermeneutic phenomenology guided the study conduct and data analysis. Data were collected via repeat individual interviews with chronically ill male parolees 40 to 65 years of age. Thirty-two in-depth interviews with 17 participants were completed. Study results included: structural barriers to health care; personal and group responses to interacting with health care while on parole and how these interactions facilitated or diminished reintegration efforts; social barriers and facilitators to health care participation, e.g. the influence of a clinican's caring professional demeanor on participation in clinical care; the role that addiction disorders play in the need to access and utilize health care; and the influence of institutional and criminal adaptations, e.g. interpersonal distrust, social isolation and institutional dependence, on reintegration efforts. These findings suggest a need for new ways of conceptualizing reintegration that includes health more centrally in the processes of success or failure. The health care system has the potential be a positive influence in these individuals' lives. In order to effectively support and care for chronically ill individuals on parole, the health care system, as an institution and as individual clinicians, must begin to integrate the problems and issues of long-term involvement in street and prison life into its evaluation and treatment of these individuals.