Health and Mental Health Service Utilization for Community Corrections-Involved Adults in Rural Oregon

Background and Purpose: Community corrections-involved (CCI) individuals, who are supervised by parole and probation officers in community settings, constitute the majority of the corrections population (Glaze & Bonczar, 2011). In rural communities, these individuals often have difficulty locating and receiving services in response to their health care needs (Staton-Tindall, McNeese, Leukefeld, et al, 2011). Unmet service needs may heighten CCI adults’ risk for substance use, unemployment, criminal activity, and recidivism (Dumont et al., 2012; Visher & Travis, 2003). In the current study, we conducted multivariate analyses of longitudinal data from a sample of rural CCI adults to identify correlates of health and mental health service utilization.

Methods: Data were gathered from 152 rural adults currently or recently supervised by parole/probation officers in Lincoln County, Oregon. Participants were randomly assigned to one of two conditions: (a) Community As Usual (CAU), where individuals participated in programs mandated by the court and/or their parole officer; or (b) Motivational Parent Management Training (MPMT), where adults attended a 12-week group parenting program with established efficacy in improving at-risk adults’ parenting, mental health, and substance use outcomes (Patterson, Reid, & Eddy, 2002). The frequency of health and mental health service use was gathered from adults via telephone interviews every 60 days; information concerning adults’ use of public/private health insurance was also gathered during each call. Information on other factors expected to be associated with service utilization was gathered at study enrollment, including assignment to CAU or MPMT, age, monthly income, race/ethnicity, and gender. Multi-level random effects logistic regression models were run in Stata 12.0 to examine trajectories of service use across 10 service points (spanning 600 days), adjusting for respondents nested within each wave.

Results: Results show that adults enrolled in MPMT were over three times more likely to report using mental health services as compared to the CAU group (OR=3.15, p<0.05). Health and mental health service use was unrelated to adults’ age, monthly income, or race/ethnicity. Rather, results suggest an interaction between gender and insurance status, such that as compared to men with no insurance, men with insurance (for health services only), women without insurance, and women with insurance had greater odds of reporting service use.

Conclusions and Implications: Results from the current study provide a contribution to prior research by identifying large gender- and insurance-based disparities in CCI adults’ service utilization, and by highlighting gains in mental health service use through participation in a parent training intervention that included a home visitation-based non-clinical case management component conducted by community paraprofessionals. Implications for social work research and practice include the need for greater attention to the health challenges facing formerly incarcerated men, who comprise most of the population supervised by county parole/probation officers. These findings also underscore the importance of developing and testing social work interventions that link community-based social workers to rural populations and promote health insurance access. Finally, findings support the testing and refinement of intervention strategies targeting the health needs of the community corrections population (Potter & Akers, 2010).