Unpacking Barriers to Accessing Services Among Black Women on Probation Who Use Drugs

Background and Purpose:

Prior research suggests several multi-level, structural, community-level and organizational factors may serve as barriers to accessing services (and service agencies among Black women, women who use drugs, and women with criminal justice involvement. Hypothesized barriers include medical mistrust, lack of health literacy, lack of cultural competency in services, experiences of stigma and discrimination associated with racism, drug use and incarceration. Yet to date, there have been few studies that elucidate the barriers for the large and growing number of Black drug-involved women in community corrections who are grapple with these intersecting stigmatized identities. This qualitative study aims to fill this gap by examining the experiences of Black women in community corrections who report using illicit drugs and/or binge drinking.

Methods:

In depth structured interviews were conducted with 45 women who identify as Black, are mandated to community corrections (probation, parole or an ATI program), and report using illicit drug or binge drinking in the past 90 days. Participants were women who participated in a randomized controlled trial testing effectiveness of E-WORTH an Afrocentric HIV prevention intervention for Black women in community corrections. Interviews elicited participant’s service needs and experience and interaction with service providers, as well as their experience of using service linkage tool of E-WORTH. Interviews were transcribed verbatim and coded thematically by two MSW level research assistants using NVivo qualitative data analysis software.

 

Findings:

The mean age of women was 31.5 (sd=11.06), 62% had less than a HS diploma, 44% were unemployed, 68% diagnosed with depression, 24.4% had been homeless in the past 90 days, and 29% did not have enough money to purchase food in past 90 days, and 71% received state/gov food assistance. Thematic analysis reveals that participants expressed primary needs around housing, employment, and education. Participants conveyed multiple experiences of feeling stigma due to drug use and criminal justice involvement were discussed, as well as participant experiences of racism from and mistrust of their health care provider.  However, participants responded positively to the service linkage tool that was part of the intervention, with some being linked to services due to the tool., Some participants reported an increased prioritization of their personal health accompanied by an increase in willingness to go to medical professionals due to their involvement in E-WORTH. Participants described a sense of “sisterhood” and “vibing” (strong social cohesion) within the Afro-centric E-WORTH intervention.

Conclusion and Implications:

Study participants described a need for a variety of services, as well as barriers to access such as stigma and mistrust of providers that aligns with current research literature. Findings suggest that culturally-specific interventions like E-WORTH can increase linkage to much needed services and address the intersection of stigma that Black women who use drugs and are involved with the criminal justice system encounter.