Implementation Evaluation of the Jail-Based OT Transition and Integration Services (OTTIS) Program

Abstract

Date Presented 04/04/19

Occupation-based, holistic re-entry programming is critical for successful transitions of individuals who are incarcerated. This study explores the fidelity of comprehensive OT services for incarcerated individuals transitioning to community life. Using a mixed-methods process evaluation, this study navigates the barriers and facilitators to the implementation of justice-based OT.

Primary Author and Speaker: Erica Skinner

Additional Authors and Speakers: Lisa Jaegers

Contributing Authors: Karen Barney, Diane Smith, Brittany Conners, Christine Hayes

Ninety-five percent of the 2.3 million individuals in United States jails will eventually return to local communities. Occupation based programming supports healthy roles, habits, routines and activities that encourage meaningful use of time for persons incarcerated and promotes the development of skills that can decrease re-offense (1). Occupational therapy (OT) programs addressing collaborative, holistic reentry services within justice settings and post transition are rare and the literature describing their formation and efficacy is scarce. Process evaluation is a method used in the formative stage of program development to determine fidelity, the extent to which a program was implemented as it was intended (2). It provides iterative feedback to continuously improve services and is necessary to inform the interpretation of related intervention efficacy study.

The purpose of this study is to describe program fidelity and explore barriers and facilitators to implementing OT services in an urban jail using ecological level descriptors. The Saint Louis University transition and integration team led by OT practitioners piloted a collaborative, pre and post-release program in an urban Midwestern jail. This study focuses on the mixed methods process evaluation of group training sessions that occurred in 2017-2018 with our first 4 cohorts of participants. Eight week modules consisted of reentry training topics, interactive discussions, applied activities, and assigned homework.

METHODS: Using session logs, the lead OT documented planned session metrics and recorded actual attendance, number released from jail, session start and end time, and level of participation. Session and team meeting notes described barriers and facilitators to carrying out each session. Logs were analyzed using descriptive statistics and qualitative analysis of notes was performed using ecological levels of barrier and facilitator codebook constructs. Two coders performed independent thematic analysis followed by consensus methods, including the programs lead OT.

RESULTS: In our first four cohorts (n=56), 24 participants successfully completed the pre-release program, 19 were released from jail (either to the community or department of corrections) prior to completing the pre-release program, 5 continued on with subsequent cohorts and a total of 3 participants were dismissed from the program. We delivered the intended training content in 136 sessions each averaging 2 hours, 7 minutes (on average 5 minutes less than the intended duration). About half of classes began on time, average session attendance was 87%, and 41% of sessions included all participants. Average completion of assigned homework was 92%. Preliminary qualitative findings indicate barriers to attendance included individual (participation, retention), OT procedure (recruitment, staffing, assessments, documentation), institutional (space, transportation, environmental conditions), community (commitment) and policy (punitive measures, unknown reentry) level challenges. Facilitators included partnership of community providers and resources, collaboration and cultural shift within jail, and individual achievements.

Occupation-based programming in justice systems is needed and there is a lack of intervention research to inform OT reentry practice. This study describes gaps in the fidelity of our pre-release program due in part to system, organizational, and individual level barriers to participation. The iterative nature of the program will inform program development and implementation to increase potential for positive impact on reentry outcomes. This proposal is important to OT practice to inform reentry program development and process evaluation methods for gaining iterative feedback on service delivery.

References

1. Eggers, M., Munoz, J. P., Sciulli, J., & Crist, P. A. (2006). The community reintegration project: occupational therapy at work in a county jail. Occupational Therapy Health Care, 20(1), 17-37. doi:10.1080/J003v20n01_02

2. Linnan, L. & Steckler, A. (2002). Process evaluation for public health interventions and research: An overview. In A. Steckler. & L. Linnan (Eds.), Process evaluation for public health interventions and research (p. 124). San Francisco, CA: JosseyBass.