While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Each year, hundreds of thousands of people are released from prison, many with health, substance abuse, economic and family problems that need to be addressed in order for them to become productive, law-abiding members of society.
From 2001 to 2008, staff at the Urban Institute analyzed the characteristics and experiences of prisoners returning from prison to homes in Baltimore, Chicago, Cleveland and Houston. The study, Returning Home: Understanding the Challenges of Prisoner Reentry, aimed to enhance understanding of former prisoners and improve policies promoting their successful reentry into society.
The Robert Wood Johnson Foundation (RWJF) provided a grant in the amount of $291,454 to the Urban Institute to partially support this project from August 2004 through December 2008.
Incarceration rates have grown four-fold from the 1970s to the 2000s, according to the Urban Institute, a Washington-based public policy institute. In 2002, more than one million people were serving time in state and federal prisons and some 600,000 were released.
"Most [individuals released from prison] will be rearrested and many will be returned to prison for new crimes or parole violations," according to an Urban Institute background paper. "And this cycle of removal and return of large numbers of individuals is increasingly concentrated in a small number of communities that already encounter enormous social and economic disadvantages. The families in these neighborhoods are those most impacted."
In recent years, public and private organizations have taken steps to improve policies and programs for former prisoners, their families and their communities. For example:
Notwithstanding these efforts, little was known about former prisoners' expectations, their employability and employment status, their health and mental health needs, their family relationships or the services they utilized.
RWJF has been interested in issues around prisoners re-entering society for more than a decade. Funded projects include:
In October 2001, the Urban Institute launched Returning Home: Understanding the Challenges of Prisoner Reentry, a multi-year, multi-state study of former prisoners, their families and their communities. Christy Visher, Ph.D., directed the study; she is now co-director of the Center for Drug and Alcohol Studies at the University of Delaware.
Returning Home's goal was "to produce concrete knowledge about prisoner re-entry and reintegration, and advance policies and innovations reflecting solid research that would inform a national dialogue to promote successful prisoner reintegration."
The project focused on cities that suffered from the highest rates of incarceration in their respective states. The states were selected to represent different inmate populations and correctional philosophies. It began with a pilot study in Baltimore, then expanded to three other cities:
The study analyzed:
The Urban Institute subcontracted with survey research firms in each city to conduct surveys of reentering prisoners:
More than 1200 men about to be released from Illinois, Ohio and Texas state prisons completed a self-administered survey, as did more than 250 women in Texas.
The research firms also conducted up to three personal interviews within 15 months after each prisoner's release. The number and schedule of the interviews varied by city due to logistical and budgetary factors. In all, more than 2,600 surveys and interviews were completed, including more than 800 approximately a year post-release. The surveys and interviews explored the respondents':
During their post-release interviews, respondents also completed screening instruments for depression and post-traumatic stress disorder.
Urban Institute researchers and the survey firms also:
Data from the Baltimore pilot project was excluded from the analysis reported here.
Returning Home ran from 2001 through 2008 and cost $6.2 million. RWJF funds partially supported data collection in Texas and a cross-site analysis of the health concerns of former prisoners, their history of substance use and treatment, and their access to health care.
The complete study was supported by 14 other funders. See the Appendix for a complete list.
Visher and her colleagues communicated findings from the study in five journal articles and in some 20 policy reports and research briefs published by the Urban Institute. For example:
See the Bibliography for a list of articles and papers, most of which are available online.
Project staff also presented findings from the study to Department of Justice and Congressional staff and at annual meetings of organizations such as the American Society of Criminology.
Project Director Christy Visher reported findings on the general characteristics of prisoners returning to the community in "Returning Home: Emerging Findings and Policy Lessons about Prisoner Reentry," an article published in the December 2007 Federal Sentencing Reporter:
Visher and Kamala Mallik-Kane reported the following findings, based on the Cleveland and Houston surveys, in a report, Health and Prisoner Reentry: How Physical, Mental and Substance Abuse Conditions Shape the Process of Reintegration:
In addition to the findings above, the researchers published findings relating to individual cities and/or issues in other publications. See the Bibliography for details.
Visher reported the following limitations of the study in a personal interview:
Visher and her colleagues made the following policy recommendations based on the findings above:
The Returning Home study ended with the conclusion of this grant. Project Director Christy Visher and colleagues plan to release a report in 2009 analyzing the substance abuse issues faced by men and women returning to the community after incarceration.
According to Visher, the study helped to inform federal officials pursuing two initiatives:
Officials in Illinois and Ohio used Returning Home data and findings to shape policies and programs.
Marcia Egbert, senior program officer at the George Gund Foundation, one of Returning Home's funders, credits Returning Home with catalyzing a broad-based effort to address reentering prisoners' needs in Cleveland. "I can trace a path from Returning Home to our launching a multi-year, multi-faceted intervention," says Egbert. "This was a jackpot for us."
Egbert reports that officials in Cleveland used data from the study to promote a comprehensive community response to people returning from prison. Among the results:
Understanding the nexus among prisoner re-entry, public health, and substance abuse
Urban Institute (Washington, DC)
Christy Visher, Ph.D.
Returning Home funders
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Visher CA and Mallik-Kane K. "Reentry Experiences of Men with Health Problems." In Public Health Behind Bars: From Prisons to Communities. Greifinger R (ed), New York: Springer, 2007, pp. 434–460.
Visher CA and Kachnowski V. "Finding Work on the Outside: Results from the 'Returning Home' Project in Chicago." In Barriers to Reentry? The Labor Market for Released Prisoners in Postindustrial America. Bushway S, Stoll MA and Weiman DF (eds), New York: Russell Sage Foundation, 2007, pp 80–113.
Visher CA, Naser RL and Courtney SME. "Incarcerated Fathers: Pathways from Prison to Home." In Incarcerated Parents, Their Children and Their Families. Gadsden V and Genty P (eds), Mahwah, NJ: Lawrence Erlbaum Publishers, forthcoming 2010.
La Vigne NG, Naser RL, Brooks LE and Castro JL. "Examining the Effect of Incarceration and In-Prison Family Contact on Prisoners' Family Relationships." Journal of Contemporary Criminal Justice, 21(4): 314–335, 2005. Available online.
Naser RL and Visher CA. "Family Members' Experiences with Incarceration and Reentry." Western Criminology Review, 7(2): 20–31, 2006. Available online.
Visher CA, La Vigne NG and Castro JL. "Returning Home: Preliminary Findings From a Pilot Study of Soon-To-Be Released Prisoners in Maryland." Justice Research and Policy, 5(2): 55–74, 2003. Abstract available online. Full article available online for a fee.
Visher CA. "Returning Home: Emerging Findings and Policy Lessons About Prisoner Reentry." Federal Sentencing Reporter, 20(2): 93–102, 2007.
Winterfield L and Castro J. "Matching Drug Treatment to Those in Need: An Analysis of Correctional Service Delivery in Illinois and Ohio." Justice Research and Policy, 7(2): 29–56, 2005. Abstract available online. Full article available online for a fee.
Visher CA, Kachnowsk V, La Vigne N and Travis J. Baltimore Prisoners' Experiences Returning Home. Washington: Urban Institute Justice Policy Center, March 2004. Available online.
Brooks LE, Visher CA and Naser RL. Community Residents' Perceptions of Prisoner Reentry in Selected Cleveland Neighborhoods. Washington: Urban Institute Justice Policy Center, March 2006. Available online.
Kachnowski V. Returning Home Illinois Policy Brief: Employment and Prisoner Reentry. Washington: Urban Institute Justice Policy Center, August 2005. Available online.
La Vigne NG, Brooks LE and Shollenberger TL. Women on the Outside: Understanding the Experiences of Female Prisoners Returning to Houston, Texas. Washington: Urban Institute Justice Policy Center, June 2009. Available online.
La Vigne NG and Kachnowski V. Texas Prisoners' Reflections on Returning Home. Washington: Urban Institute, October 2005. Available online.
La Vigne NG, Kachnowski V, Travis J, Naser R and Visher C. A Portrait of Prisoner Reentry in Maryland. Washington: Urban Institute Justice Policy Center, March 2003. Available online.
La Vigne NG, Mamalian CA, Travis J and Visher C. A Portrait of Prisoner Reentry in Illinois. Washington: Urban Institute Justice Policy Center, April 2003. Available online.
La Vigne NG and Parthasarathy B. Returning Home Illinois Policy Brief: Prisoner Reentry and Residential Mobility. Washington: Urban Institute Justice Policy Center, August 2005. Available online.
La Vigne NG, Shollenberger TL and Debus SA. One Year Out: Tracking the Experiences of Male Prisoners Returning to Houston, Texas. Washington: Urban Institute Justice Policy Center, June 2009. Available online.
La Vigne NG, Thomson GL, Visher C, Kachnowski V and Travis J. A Portrait of Prisoner Reentry in Ohio. Washington: Urban Institute Justice Policy Center, March 2003. Available online.
La Vigne NG, Visher C and Castro J. Chicago Prisoners' Experiences Returning Home. Washington: Urban Institute, December 2004. Available online.
Mallik-Kane K. Returning Home Illinois Policy Brief: Health and Prisoner Reentry. Washington: Urban Institute Justice Policy Center, August 2005. Available online.
Mallik-Kane K and Visher CA. Health and Prisoner Reentry: How Physical, Mental and Substance Abuse Conditions Shape the Process of Reintegration. Washington: Urban Institute, February 2008. Available online.
Shollenberger TL. When Relatives Return: Interviews with Family Members of Returning Prisoners in Houston, Texas. Washington: Urban Institute Justice Policy Center, May 2009. Available online.
Visher C, Baer D and Naser R. Ohio Prisoners' Reflections on Returning Home. Washington: Urban Institute, January 2005. Available online.
Visher CA and Courtney SME. Cleveland Prisoners' Experiences Returning Home. Washington: Urban Institute, September 2006. Available online.
Visher CA, Debus S and Yahner J. Employment after Prison: A Longitudinal Study of Releasees in Three States. Washington: Urban Institute Justice Policy Center, October 2008. Available online.
Visher C and Farrell J. Chicago Communities and Prisoner Reentry. Washington: Urban Institute, September 2005. Available online.
Visher C, Kachnowski V, La Vigne N and Travis J. Baltimore Prisoners' Experiences Returning Home. Washington: Urban Institute, March 2004. Available online.
Visher CA, Knight C, Chalfin A and Roman J. The Impact of Marital and Relationship Status on Social Outcomes for Returning Prisoners. Washington: Urban Institute Justice Policy Center, February 2009. Available online.
Visher C, La Vigne NG and Farrell J. Illinois Prisoners' Reflections on Returning Home. Washington: Urban Institute, September 2003. Available online.
Visher C, La Vigne N and Travis J. Returning Home: Understanding the Challenges of Prisoner Reentry. Maryland Pilot Study: Findings from Baltimore. Washington: Urban Institute Justice Policy Center, January 2004. Available online.
Visher C, Naser RL, Baer D and Jannetta J. In Need of Help: Experiences of Seriously Ill Prisoners Returning to Cincinnati. Washington: Urban Institute, March 2005. Available online.
Watson J, Solomon AL, La Vigne NG, Travis J, Funches M and Parthasarathy B. A Portrait of Prisoner Reentry in Texas. Washington: Urban Institute Justice Policy Center, March 2004. Available online.
Winterfield L and Castro J. Returning Home Illinois Policy Brief: Treatment Matching. Washington: Urban Institute Justice Policy Center, August 2005. Available online.
Report prepared by: Mary Nakashian
Reviewed by: Robert Narus
Reviewed by: Molly McKaughan
Program Officer: Nancy L. Barrand
Former Program Officer: Floyd Morris
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