Oser Carrie B, Rockett Maria, Otero Sebastian, Batty Evan, Booty Marisa, Gressick Rachel, Staton Michele, Knudsen Hannah K
Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY, 40506, USA.
Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 1515 Patterson Office Tower, Lexington, KY, 40508, USA.
Health Justice. 2024 Mar 26;12(1):12. doi: 10.1186/s40352-024-00266-9.
The COVID-19 pandemic produced system-level changes within the criminal legal system and community-based substance use disorder (SUD) treatment system with impacts on recovery efforts. This study examines rural and urban clinicians' perspectives of COVID-19 on SUD treatment delivery for people on community supervision.
Virtual qualitative interviews were conducted between April and October 2020 with 25 community supervision clinicians employed by Kentucky's Department of Corrections (DOC), who conduct assessments and facilitate community-based treatment linkages for individuals on probation or parole. Transcripts were analyzed in NVivo using directed content analysis methods.
Clinicians were predominantly white (92%) and female (88%) with an average of over 9 years working in the SUD treatment field and 4.6 years in their current job. Four COVID-19 themes were identified by both rural and urban clinicians including: (1) telehealth increases the modes of communication, but (2) also creates paperwork and technological challenges, (3) telehealth requires more effort for inter/intra-agency collaboration, and (4) it limits client information (e.g., no urine drug screens). Two additional rural-specific themes emerged related to COVID-19: (5) increasing telehealth options removes SUD treatment transportation barriers and (6) requires flexibility with programmatic requirements for rural clients.
Findings indicate the need for community-based SUD treatment providers approved or contracted by DOC to support and train clients to access technology and improve information-sharing with community supervision officers. A positive lesson learned from COVID-19 transitions was a reduction in costly travel for rural clients, allowing for greater engagement and treatment adherence. Telehealth should continue to be included within the SUD continuum of care, especially to promote equitable services for individuals from rural areas.
新冠疫情在刑事法律系统和社区药物使用障碍（SUD）治疗系统中引发了系统性变化，对康复工作产生了影响。本研究考察了农村和城市临床医生对新冠疫情对社区监管人员药物使用障碍治疗服务提供情况的看法。
2020年4月至10月期间，对肯塔基州惩教部（DOC）雇佣的25名社区监管临床医生进行了虚拟定性访谈，这些临床医生负责对缓刑或假释人员进行评估，并促进基于社区的治疗联系。使用定向内容分析法在NVivo中对访谈记录进行了分析。
临床医生主要为白人（92%）和女性（88%），平均在药物使用障碍治疗领域工作超过9年，在目前岗位工作4.6年。农村和城市临床医生都确定了四个与新冠疫情相关的主题，包括：（1）远程医疗增加了沟通方式，但（2）也带来了文书工作和技术挑战，（3）远程医疗需要机构间/机构内协作付出更多努力，以及（4）它限制了客户信息（例如，无法进行尿液药物筛查）。另外出现了两个与新冠疫情相关的农村特有的主题：（5）增加远程医疗选项消除了药物使用障碍治疗的交通障碍，以及（6）需要对农村客户的项目要求保持灵活性。
研究结果表明，需要由惩教部批准或签约的基于社区的药物使用障碍治疗提供者来支持和培训客户使用技术，并改善与社区监管人员的信息共享。从新冠疫情期间的转变中学到的一个积极经验是，农村客户的昂贵出行减少了，从而提高了参与度和治疗依从性。远程医疗应继续纳入药物使用障碍连续护理体系，特别是为了促进为农村地区的个人提供公平服务。
