2023 HSR&D/QUERI National Conference

4012 — “Just human things”: Defining peer activities meaningful to reentry Veterans in the process of transition from incarceration to community settings

Lead/Presenter: Kimberlee Flike,  COIN - Bedford/Boston
All Authors: Flike KL (Center for Healthcare Organization and Implementation Research, Bedford), Richardson E (Center for Healthcare Organization and Implementation Research, Boston) Petrakis, BA (Center for Healthcare Organization and Implementation Research, Bedford) Hyde, JK (Center for Healthcare Organization and Implementation Research, Bedford) McInnes, DK (Center for Healthcare Organization and Implementation Research, Bedford) Kim, B (Center for Healthcare Organization and Implementation Research, Boston)

Annually, between 12,000 and 16,000 Veterans are reintegrated into communities after incarceration, with many at risk of homelessness, overdose, and suicidal ideation. Interventions that support their reentry by connecting them to needed services is vital to prevent recidivism and enhance successful reintegration. The Post-Incarceration Engagement (PIE) intervention links reentry Veterans with a peer specialist who provides connection to services and socio-emotional support. This presentation uses an established framework for peer-based interventions to organize and communicate the key qualities and activities of peer specialists that impacted a sample of PIE enrolled Veterans in their reentry process.

We interviewed 25 Veteran PIE participants about their reentry experience and their expectations and feedback on working with a peer specialist. We conducted a grounded thematic analysis of the data. Using an inductively developed codebook, two project team members independently coded interviews then reached consensus on the coding. Team members then identified themes that emerged from the coded data. Findings were mapped onto the core components of an intervention model developed for mental health services called Stepped Model of Peer Provision. The core components include: (1) Creating a Safe Place, (2) Working Partnership and (3) Stepping Out.

Reentry Veterans described external stressors that influenced their lived experiences at each of the three steps of the model. These stressors included social stigma, unmet social needs, and complicated relationships. Veterans indicated that peer specialists Created a Safe Place through meeting immediate physical/social needs, building relationships pre-release, letting the Veteran set the pace, being reliable, and providing hope for a better future. Peer activities key to developing a Working Partnership were helping to identify realistic goals, providing assistance navigating health and social systems, and using role modeling/storytelling as exemplars for how to reintegrate. Emergent themes under Stepping Out included providing support and guidance until Veterans felt comfortable accomplishing key activities on their own and feeling like the peer will continue to be a trusted source of support when needed. The importance of the peer specialists’ lived experience also emerged and was consistently integrated into each of the three steps. Veterans felt safe to share because they knew the peer “had been there”.

The perspectives of the reentry Veterans aligned closely to the Stepped Model of Peer Provision for post-incarceration support efforts. The peer was able to create safety through addressing/alleviating the external stressors, enter a working partnership with the Veteran and eventually enable the Veteran to step out on their own for a successful reentry. The Stepped Model served as a useful framework for understanding how forensic peer specialists supported reentry Veterans as they reintegrated back into the community.

Categorizing peer activities and qualities per the Stepped Model of Peer Provision may help structure peer specialist-Veteran relationships for more consistent and effective implementation of PIE and other peer specialist interventions. Incorporating findings from this project into PIE implementation may allow a greater reach of peer specialists and increase equity in the health and social care of vulnerable Veterans reintegrating into the community post-incarceration.