Institute for Health Equity and Social Justice Research, Northeastern University, Boston (Adams, Lincoln); Department of Sociology, California State University, East Bay, Hayward (Adams).
Psychiatr Serv. 2021 Jun;72(6):626-632. doi: 10.1176/appi.ps.201900627. Epub 2021 Mar 18.
This study sought to examine perceived barriers to and facilitators of the adoption, implementation, and sustainability of community-based mental health peer support services for criminal justice-involved individuals, also known as "forensic peer support" (FPS).
Qualitative interviews were conducted with stakeholders (N=14) and peer specialists (N=37) to better understand delivery of peer support services for justice-involved individuals in Pennsylvania. Thematic analysis followed by directed content analysis was used to identify factors in three a priori implementation categories based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model: initial facilitators (adoption), barriers (implementation), and facilitators (maintenance) to long-term sustainability.
Initial service adoption was facilitated by buy-in from recovery-oriented gatekeepers in the criminal justice system. Unique implementation barriers included the chasm between the orientations of the two systems (recovery vs. punitive) and formal and informal limitations on the employment of individuals with criminal justice system exposure. For services to be sustainable and have an impact over the long term, FPS advocates and workers must develop rapport with on-the-ground employees of the criminal justice system. Funding barriers specific to the criminal justice system limited the adoption, implementation, and maintenance of FPS services.
Although many of the factors that affect FPS service implementation were similar to those identified in the broader peer support literature, important differences must be addressed for successful FPS service delivery. Within the criminal justice system, both policies and norms presented barriers to the expansion of peer support services for justice-involved individuals.
本研究旨在探讨社区心理健康同伴支持服务（也称为“法医同伴支持”）在刑事司法涉案人员中的采用、实施和可持续性面临的障碍和促进因素。
对利益相关者（N=14）和同伴专家（N=37）进行了定性访谈，以更好地了解宾夕法尼亚州为涉案人员提供同伴支持服务的情况。采用主题分析和有针对性的内容分析，根据 RE-AIM（涵盖范围、效果、采用、实施和维持）模型的三个预先确定的实施类别，识别因素：初始促进因素（采用）、障碍（实施）和长期可持续性的促进因素（维持）。
初始服务采用得益于刑事司法系统中以康复为导向的把关人的认可。独特的实施障碍包括两个系统（康复与惩罚）的取向之间的差距，以及对具有刑事司法系统背景的个人的正式和非正式就业限制。为了使服务具有可持续性并能长期产生影响，法医同伴支持服务的倡导者和工作人员必须与刑事司法系统的实地员工建立融洽关系。专门针对刑事司法系统的资金障碍限制了法医同伴支持服务的采用、实施和维持。
尽管影响法医同伴支持服务实施的许多因素与更广泛的同伴支持文献中确定的因素相似，但要成功提供法医同伴支持服务，还必须解决重要的差异。在刑事司法系统内，政策和规范都对为涉案人员扩大同伴支持服务构成了障碍。
