Co-Design of Services for Health and Reentry (CO-SHARE)

An Experience-Based Co-Design (EBCD) Pilot Study with Individuals Returning to Community from Jail and Service Providers in Los Angeles County

by Peter Mendel, Lois M. Davis, Susan Turner, Gabriela Armenta, Cedric Farmer, Cheryl Branch, Glenn Robert

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Research Questions

  1. What are key priority areas for improvement for community health and reentry services in Los Angeles County?
  2. How can solutions for the gaps and barriers to access, quality, and coordination of reentry services be co-designed by returning individuals and service providers?
  3. How can EBCD be best adapted to the design of user-centric health and related systems of care for the reentry and other vulnerable populations in the United States?

Individuals returning to the community from jail often face difficulties accessing the varied health, social, and other services required to improve reentry and reduce recidivism. This report describes a pilot study, the Co-Design of Services for Health and Reentry (CO-SHARE), that used an innovative, evidence-based method known as Experience-Based Co-Design (EBCD) for returning individuals and service providers to collaboratively identify priority needs and recommendations for improving health and reentry services in Los Angeles County.

CO-SHARE is the first pilot study of EBCD in the United States. Results of the project focused on both the feasibility of applying EBCD in a community-wide service system in the United States and the recommendations concerning promising solutions and key design principles generated by study participants for improving services for the reentry population in Los Angeles County.

The findings should be of value to policymakers, funding organizations, service providers, and community advocates interested in new methods for meaningfully engaging reentry and other vulnerable populations in improving the safety net systems they rely on.

Key Findings

The CO-SHARE study demonstrated successes, adaptations, and limitations

  • The study facilitated participants' ability to work together in a respectful and collaborative environment toward a common objective, and the time invested helped build familiarity and trust between returning citizens and service providers.
  • Adaptations included scoping the study and sampling participants for a community-wide context, additional facilitation techniques to empower returning individuals, and abridging the extent of the co-design workgroups.
  • The process could have been improved by reducing the time between study activities and increasing the time spent in activities.
  • Perspectives of women and other reentry groups, such as LGBTQ and younger returning individuals, were relatively underrepresented in the project.
  • The study was limited in its ability to implement concrete improvements across such a spatially and organizationally diffuse set of service systems for returning individuals.

Returning citizens and service providers jointly identified four high-priority service topics for improvement of the health and reentry system in Los Angeles

  • The first is the prerelease process, which prepares individuals for key reentry needs before leaving jail.
  • The second is one-stop service hubs, which offer a range of reentry services in one location or nearby locations.
  • The third is housing opportunities that are affordable, safe, long term, and located near work and family obligations.
  • The fourth is long-term support to sustain reentry and integration into community.

Study participants also generated recommendations concerning promising solutions and key design principles for each priority topic

Recommendations

  • For the prerelease process from jail, improve returning individuals' connections with and trust in services before release from jail (e.g., easier access to jails by community-based service providers, having a trusted service provider meet returning individuals directly upon release) and improve communication among service providers to better prepare for and coordinate services for returning citizens (e.g., shared data systems).
  • For one-stop service hubs, provide as many direct services in one place as possible and minimize referrals to services in other areas, include a full range of both court-ordered and other services needed for successful reentry, locate service hubs outside of probation-branded facilities, and closely link hubs with the prerelease process.
  • For housing opportunities, creatively use existing infrastructure to increase housing capacity quickly (e.g., convert recently closed county juvenile and similar facilities, engage private landlords to vouch for and support renting to returning individuals) and improve awareness of existing programs successful in preparing and placing returning individuals into suitable housing.
  • For long-term support, provide continual access to "reentry navigators" to help returning individuals develop tailored long-term plans, identify relevant resources, and connect to services as needed; develop formal peer and mentor support programs to provide encouragement, information, and sense of belonging along the challenging reentry journey; and advocate for state policies to facilitate long-term reentry (e.g., easier or automatic expungements of criminal records after time served).

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Study Design

  • Chapter Three

    Results on Needs and High-Priority Topics Identified by Participants for Health and Reentry Services in Los Angeles

  • Chapter Four

    Participant Recommendations for Improving Four High-Priority Health and Reentry Service Topics in Los Angeles

  • Chapter Five

    CO-SHARE Results on the EBCD Process: Participant Experience and Implementation Lessons

  • Chapter Six

    Conclusions and Next Steps

Research conducted by

The research described in this report was sponsored by the Robert Wood Johnson Foundation and conducted by the Quality Measurement and Improvement Program within RAND Health Care.

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