Centre for Social Research in Health, UNSW Sydney, Australia.
Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia.
Int J Drug Policy. 2021 Sep;95:103261. doi: 10.1016/j.drugpo.2021.103261. Epub 2021 May 11.
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.
This qualitative study recruited participants from SuperMIX, (a longitudinal cohort study in Victoria, Australia).
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.
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.
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.
获得服务是成功重返社区（重新融入）的关键，而许多人无法获得服务，包括注射吸毒者（PWID）。我们使用案例研究方法和结构能力概念，来研究一组最近从监狱获释的 PWID 获得服务的影响因素。
本定性研究从 SuperMIX（澳大利亚维多利亚州的一项纵向队列研究）招募参与者。
年龄在 18 岁及以上；有终生注射吸毒史；监禁超过三个月且在过去 12 个月内被释放。从 48 名参与者中，选择了 5 个案例研究，这些案例研究是参与者错过服务预约时发生的复杂且相互交织的因素的典型代表。
参与者生活中的众多、并发且相互依存的结构性影响因素与他们难以获得和维持与服务的联系并导致错过预约的情况同时发生。这里介绍的案例的关键因素包括阿片类激动剂治疗的政策、不充分、不合适和不安全的住房、心理健康和治疗副作用的管理、缺乏社会支持或与家人疏远、以及经济困难。服务工作者提供的支持不一致。还研究了一个例外案例，即预期并接受错过预约的情况。
案例研究方法能够全面深入地检查与有限的社会和经济资源相交错的上游结构要素，这些要素加剧了社区重返的挑战。这些结果突出了对 PWID 的选择和机会产生不成比例影响的结构性问题。在服务设计和工作人员培训中纳入结构能力框架，可以支持以个人为中心和协调的服务提供，考虑到 PWID 出狱后的经历，克服服务参与的结构性障碍。
