Community Supervision Engagement to Examine Health Outcomes: A Scoping Review

ABSTRACT

Introduction

We reviewed the literature related to what is known about community supervision engagement to address health outcomes amongst individuals with criminal justice oversight.

Methods

We searched eight databases. After removing duplicates, we reviewed 482 article titles and abstracts and retrieved 56 articles for full‐text review.

Results

Eleven articles met final inclusion. The findings are organized into two themes: (1) Health Outcomes and (2) Programming Issues. Two studies focused on health outcomes, eight on programmatic implementation, and one on health outcomes and implementation. Only one study involved gender‐specific programming for childbearing women.

Conclusion

More research that utilizes randomized control trial methods, larger samples, and measures to evaluate the effectiveness of community‐based programming on health outcomes within community supervision is warranted. Considering women of childbearing age are most likely deferred to community supervision and maternal and child morbidity and mortality is an ever‐growing public health crisis, more investigation is needed specific to this population.

1. Background

As a result of mass incarceration in the United States, the number of people on community supervision, also known as probation or parole, has quadrupled since the 1980s (Heimer et al. 2023; Phelps 2020). Across the past four decades, the population on community supervision has risen from 1.1 to 4.3 million, or roughly 56% of the 6.6 million adults under criminal justice control are placed on probation (Phelps 2020). Those from underserved communities have the most significant risk of experiencing arrest and correctional oversight including community supervision (Ghandnoosh 2023). These populations have poorer social determinants of health associated with limited food security, safe housing, transportation, employment and educational attainment, and healthcare, which prompts adverse experiences, ineffective coping behaviors, and chronic or acute disease (Maness et al. 2021; Yearby 2020).

Consequently, these individuals first access correctional systems with less optimal health than broader society (Kajeepeta et al. 2021; Massoglia and Remster 2019). Health conditions such as mood disorders (anxiety, depression), substance use disorder (smoking, alcohol, illicit substances), cardiovascular disease, diabetes, sexually transmitted infections, and human immunodeficiency virus (HIV) are more prevalent in individuals who experience justice system involvement compared to those that never experience arrest and detainment (Kajeepeta et al. 2021; Massoglia and Remster 2019). The stress and barriers that follow confinement in jail and prison exacerbate chronic health conditions, leading to increases in morbidity and mortality (Massoglia and Remster 2019).

Community supervision is considered a diversion or alternative to formal detainment in prison; however, the obligations and constraints associated with this type of correctional oversight limit opportunities for those detained in this way to balance their healthcare needs (Lorvick et al. 2022; Phelps 2020; Van Deinse et al. 2020). Community supervision usually requires daily or weekly meetings, training or classes, and financial sanctions that often cause those detained in this way to prioritize their community supervision requirements over health management issues (Hawks et al. 2020). As community supervision departments have expanded and improved their services to meet the needs of their clients within the community, health as an essential factor in completing community supervision requirements has received greater recognition (Marder and Rossner 2021; Massoglia and Remster 2019).

Officers within probation and parole departments are pivotal in identifying clients for services, program/intervention initiation and sustainment, and outcome evaluation (Brown et al. 2019). In the past, comprehensive approaches to programming and examining health outcomes have been implemented, mainly in jail and prison settings. These practices continue to be necessary to improve in these settings. Nevertheless, diverting more clients from incarceration to community supervision warrants extending these practices to those settings. To date there is limited evidence‐based practice in community supervision spaces which points to a need to prioritize access to community‐based services that address all the incept points prior to detention (Crawford et al. 2024; Lorvick et al. 2022; Van Deinse et al. 2020, 2022, 2023). This includes deflection to services via crisis intervention. Therefore, the purpose of this scoping review is to assess the extent and gaps in the literature related to community supervision engagement to address health outcomes and provide a better understanding of the effectiveness, facilitators, and barriers to existing strategies.

2. Methods

We conducted a scoping review to deepen our knowledge about the extent and gaps in the literature regarding community supervision engagement to examine health outcomes. Thus, we aimed to address the following research questions: (1) What is known about community supervision engagement in examining health outcomes? (2) What type of health outcomes are examined in populations on community supervision? (3) How does engagement within community supervision departments and public health assist in tracking or influencing these health outcomes? (4) What facilitators and barriers exist to program implementation of these current strategies within community supervision?

A health sciences librarian searched for related reviews across Prospero, TRIP Database, PubMed, and OSF Registries. We developed a protocol a priori and registered on December 22, 2023, at the Joanna Briggs Institute. In September 2023, we searched eight bibliographic databases: PubMed, CINAHL, Scopus, Public Health Database, PsycINFO, SocINDEX, EBSCO Criminal Justice Abstracts, and ProQuest Social Sciences collection. The search algorithm was developed in coordination with a health sciences librarian and is detailed in Table S1, which combined keywords and subject headings related to community supervision engagement addressing health disparities. Table 1 contains definitions for the data items.

TABLE 1.

Definitions used for data items included in the scoping review process.

#	data item	Definition
1	Community supervision	Oversight of someone who has a criminal offense in the residence/community versus in a jail or prison setting. There are two main types of community supervision: parole and probation (Bureau of Justice, no date).
2	Drug court	Specialized court docket programs that help criminal defendants and offenders, juvenile offenders, and parents with pending child welfare cases who have alcohol and other drug dependency problems (United States Department of Health and Human Services, no date).
3	Hybrid design	A study design that has a dual focus: to assess clinical effectiveness and implementation and can take one of three approaches: (a) test effects of intervention on outcomes while observing implementation, (b) dual testing of clinical and implementation interventions/strategies, (c) testing implementation while observing and gathering information on the intervention's impact on outcomes (Curran et al. 2012).
4	Implementation science	Methods and strategies that facilitate the uptake of evidence‐based practice and research into regular use by practitioners and policymakers (University of Washington 2023).
5	Mental illness	Mental illnesses are health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses can be associated with distress and/or problems functioning in social, work or family activities (American Psychiatric Association 2023).
6	parole	Parole refers to criminal offenders who are conditionally released from prison to serve the remaining portion of their sentence in the community (Bureau of Justice, no date).
7	probation	Probation refers to adult offenders whom courts place on supervision in the community through a probation agency, generally in lieu of incarceration (Bureau of Justice, no date).
8	Probation officer	The professional within the community corrections department (probation) that gives oversight to the person on probation (Bureau of Justice, no date).
9	Justice system	A term that describes the agencies and institutions that enforce the law regarding criminal or civil issues (Cornell Law n.d.).
10	Randomized control trial	Randomized controlled trials (RCT) are prospective studies that measure the effectiveness of a new intervention or treatment (Hariton and Locascio 2018).
11	Treatment for substance use	Program designed to assist people to stop or decrease the use of illicit substances (Center for Substance Abuse Treatment 2004).
12	Women's health	A broad category that includes health issues that are unique to women, such as menstruation and pregnancy, as well as conditions that affect both men and women, but that may affect women differently, such as heart disease and diabetes (National Institute of Child Health and Human Development 2023).

Given our initial search and the uniqueness of our questions, we did not apply but limited our results to English‐language articles. We did not conduct a gray literature search since we included only published, peer‐reviewed literature. This scoping review followed PRISMA‐ScR (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews) guidelines (Peters et al. 2020). We subjected the search to a PRESS peer review using a modified PRESS document (McGowan et al. 2016), which we then translated into all included databases.

Across all the databases, the search produced 655 total results. After we removed duplicates, 482 results remained for the title and abstract screening. We then uploaded the citations into Rayyan QCRI, a freely accessible web‐based resource that facilitates blinded reviews for research teams’ collaborative analysis of results (Ouzzani et al. 2016). The first stage of the review process involved two research team members independently and blindly reviewing the titles and abstracts. A third reviewer reconciled conflicts. The reasons for exclusion at this stage were that the research addressed the wrong outcome, the publication type (not research), and published outside of the United States, which left 56 articles for full‐text review. The second stage of the review process included the evaluation of the complete texts and followed the same strategy as the first stage. Out of the 56 articles for full‐text review, 39 were not retrieved due to wrong publication type or outcome leaving 17 retrieved. In all, eleven articles met final inclusion, while we excluded six for wrong outcomes outside of pregnancy, childbirth or postpartum such as autoimmune disease, blood disorders, and chronic conditions not associated with pregnancy such as diabetes, high blood pressure, genetic disorders, and so forth (see Figure 1) (Page et al. 2021).

FIGURE 1.

Prisma flow diagram of the independent review of articles that met inclusion and reasons for exclusion. Source: Page et al. 2021 [Colour figure can be viewed at wileyonlinelibrary.com]

3. Results

3.1. Study Characteristics

By conducting this scoping review of the literature, we analyzed the extent of the data specific to how previous research used community supervision engagement to examine health outcomes and program implementation. A total of N = 11 articles met the final inclusion with dates ranging from 1999 to 2023. Two studies focused on health outcomes (Roskes and Feldman 1999; Van Deinse et al. 2022) while eight studies focused on programming in community supervision departments that utilized engagement with public health services (Booty et al. 2023; Hunter et al. 2020; Kennedy et al. 2020; Lasher and Stinson 2020; Lichtenstein et al. 2016; Matejkowski and Severson 2020; Myers et al. 2022; Van Deinse et al. 2020). Lastly, one study focused on both health outcomes and implementation to programming and gender‐specific programming for women on community supervision (Bardin et al. 2022).

As shown in Tables 2 and 3, we extracted the following data from the studies: authors’ names and years of publication, location of the study within the United States, place of community supervision (probation, parole, court‐mandated treatment of substance use disorder), methods, and measures. We referenced the recommendations provided by each study in Table 4 which may be helpful for those working within public health and community supervision sectors. We organized the findings into two themes and correlating subthemes: (1) Health Outcomes (subthemes: a. Substance Use and b. Mental Illness) and (2) Programming (subthemes: a. Facilitators and b. Barriers).

TABLE 2.

Summary of studies related to community supervision engagement to address health outcomes.

Author, year	Sample size, location and objective	Methods and measures
Bardin et al. 2022	N = 132 Women on probation in the Female Offenders Can Ultimately Succeed (FOCUS) program in Upstate New York Evaluated program implementation for an extended‐release medication, naltrexone (XR‐NTX, Vivitrol) versus buprenorphine and methadone for medications for opioid use disorder (MOUD).	Qualitative interviews Process evaluation Computerized survey Medical data from chart review and community health workers (CHWs) files: clinic attendance and referrals to substance use and mental health treatment. Officers and CHWs provided feedback regarding client engagement while on FOCUS Semi‐structured interview: Clients were asked to identify program aspects, comparing FOCUS to prior legal and medical experiences, also asked how FOCUS addressed challenges in completing probation, sharing motivation for or hindrances in survey completion, and describe relationships with officers, physician, and CHW. Self‐administered client survey: Global Appraisal of Individual Needs (GAIN) scale
Roskes and Feldman 1999	N = 16 Men and women on probation with mental illness in Baltimore. Evaluated the health outcomes of people on probation assigned to one assigned officer working with a mental health treatment program which provided medical care, intense case management, treatment for substance use disorder, urinalysis, and inpatient or residential rehabilitation services.	A community mental health model: each person on probation is assigned to a psychiatrist, a master's‐level therapists and probation officer. Care includes: medical treatment, intensive case management, treatment for substance use disorder, urine toxicology screening, and psychosocial or residential rehabilitation services. Decisions about changes in patients’ housing, major alterations of the treatment plan, or discontinuation of services always involve the probation officer's input.
Van Deinse et al. 2022	N = 100 men and women on probation Divided between two rural and urban counties in a Southeastern state. n = 47 in SMHP programming (rural county, n = 21; urban county, n = 26) n = 53 standard probation (rural county, n = 20; urban county, n = 33). To measure the adoption of specialty mental health probation (SMHP) in both types of counties and analyze its impact on mental health and community supervision outcomes	Randomized control trial Demographics: prior probation sentence, self‐report service engagement, and administered standardized measures: 1. Symptom checklist‐10 2. Dual role relationship inventory revised 3. Internalized stigma of mental illness Data pertaining to criminogenic risk, needs, and supervision level derived from the state's risk and needs assessment. Administrative data were obtained from the Department of Public Safety at the end of the study period: probation officer action steps and probation violations

TABLE 3.

Summary of studies related to community supervision engagement to address program implementation.

Author, year	Sample, location, and objective	Methods and measures
Bardin et al. 2022	N = 132 Women on probation in the Female Offenders Can Ultimately Succeed (FOCUS) program in Upstate New York Evaluated program implementation for an extended‐release medication, naltrexone (XR‐NTX, Vivitrol) versus buprenorphine and methadone for medications for opioid use disorder (MOUD).	Qualitative interviews; Process evaluation; Computerized survey Medical data from chart review and community health workers (CHWs) files: clinic attendance and referrals to substance use and mental health treatment. Officers and CHWs provided feedback regarding client engagement while on FOCUS Semi‐structured interview: Clients were asked to identify program aspects, comparing FOCUS to prior legal and medical experiences, also asked how FOCUS addressed challenges in completing probation, sharing motivation for or hindrances in survey completion, and describe relationships with officers, physician, and CHW. Self‐administered client survey: Global Appraisal of Individual Needs (GAIN) scale
Booty et al. 2023	N = 25 Social service clinicians in the Kentucky Department of Corrections probation and parole Offices Examined clinicians’ perspectives of factors associated with the criminal justice system and people needing medication for period use disorder (MOUD).	Qualitative Used the socioecological framework to consider intrapersonal, interpersonal, and institutional factors that facilitated or hindered the medication for opioid use disorder MOUD continuum of care among their clients upon reentry into the community once released from incarceration. Questions focused on: Extended‐release naltrexone was the primary MOUD; initiation and continuity of buprenorphine; social service clinicians’ perceptions of methadone treatment; roles, knowledge, and opinions related to MOUD: (e.g., “What are your views on buprenorphine as a treatment for opioid use disorder?”)
Hunter et al. 2020	N = 310 Individuals on probation in the Southwestern region of the United States Examined a 24/7 sobriety program within a probation department.	Qualitative Semi‐structured interview protocol with questions that were adapted from the Consolidated Framework for Implementation Research (CFIR) interview guide related to the five CFIR domains which are: outer setting, inner setting, characteristics of the intervention, process, and characteristics of individuals
Kennedy et al. 2020	N = 31 participants N = 20 interviews Administrators in probation departments across the United States. Conducted in‐depth interviews of officials in community supervision of the structural and organizational factors of MOUD.	Qualitative The interview guide included questions about the community supervision agency and its structure, culture, MOUD treatment policies and practices, interaction and coordination with adjacent institutions in the criminal‐legal system, mechanisms for financing treatment, and relationships with community treatment providers.
Lasher and Stinson 2020	N = 38 total n = 33 mental health providers n = 4 officers Southern Appalachian region of the United States. To understand mental health and probation and parole officers’ experiences providing services.	Qualitative Demographic survey (job activity, tole, etc.) Interview questions for mental health and officers (e.g., “how important in communication with other providers or people who are serving your clients?”)
Lichenstein et al. 2016	N = 8 officers N = 335 men on probation or parole Tuscaloosa County, Alabama, Probation and Parole Office To implement an on‐site HIV service for those on probation or parole which utilized a university, law enforcement, and HIV agency.	Quantitative Cross sectional survey analysis Officers 1) 15‐item scale/textbox survey: officers’ knowledge about HIV transmission, prevention and treatment modalities. 2) 23‐item scaled/textbox survey on HIV knowledge, safety concerns, program effectiveness, time demands and future directions. 3) Informal feedback on offenders’ interest in the Program People on probation or parole were organized into two groups: new offenders attended fortnightly orientation sessions; current offenders reported for mandated monthly visits. New People with offenses Met with the HIV educator in groups of 16–22 people, where HIV risks, prevention, testing and treatment were discussed in roundtable fashion. Current offenders received a flyer with sign‐in forms and an invitation to speak to their assigned officer about the HIV services. The educator kept a record of all visits by group assignment and provided aggregate information on offenders’ demographics and points of contact.
Matejkowski and Severson 2020	N = 291 Probation and parole officers across the United Stated within the American Probation and Parole Association (APA) To identify predictors of positive attitudes toward the use of shared decision making with people with severe mental illness who are on community supervision.	Quantitative Survey Study Officer Demographics and Training Organizational Characteristic's Beliefs about Clients Community Corrections Shared Decision Making Scale: consists of seven items on attitudes supportive of collaborative decision making between corrections officers and those they supervise. Face and content validity were assessed by the scale's developers. Responses are scored on a 1‐to‐4, strongly‐disagree‐to‐strongly‐agree, Likert scale.
Myers et al. 2022	N = 19 Mental health (MHSs) and criminal justice system (CJSs) professionals in the Judge Ed Emmett Mental Health Diversion Center (JEEDC) jail diversion program in Houston, Texas To explore the perspectives of a jail diversion program that serves individuals with serious mental illness and homelessness.	Qualitative and demographic data Interviews looked at barriers and facilitators to client engagement in the JEEDC. Administrative Data was also observed: a program evaluation, a PowerPoint presentation, a July newsletter, and an e‐mail. Demographic characteristics showed that since 2018, 1170 individuals who were Diverted had a serious mental illness
Van Deinse et al. 2020	N = 16 Specialty mental health probation (SMHP) officers and their supervising chiefs in a Southeastern state n = 9 SMHP officers n = 7 chiefs Explore and identify the resources that probation officers need to implement specialized mental health probation caseloads.	The semi‐structured interview guide was designed to inquire about: perspectives of the intervention, recipient characteristics, implementation and sustainability infrastructure, and external environment. Specialty mental health probation officers and chiefs were asked to describe: (1) their perspectives on the core components of their role: ideal caseload size and number of people with mental illnesses they supervised, and whether they supervised an exclusively mental health or mixed caseload; (2) officers’ and chiefs’ personal characteristics, background, and examples of how they and their colleagues identify and supervise people with mental illnesses; (3) the type and frequency of specialized trainings and other professional resources officers and chiefs have participated in or need to implement the specialty mental health probation model; and (4) the influence of external environmental factors on SMHP delivery.

TABLE 4.

Recommendations for program implementation using community supervision engagement to address health outcomes in community supervision.

Author, year	Recommendations
Bardin et al. 2022	Assisting with health literacy will improve outcomes in women needing specialized programming. Flexible appointment times that allow women to bring children to meetings should be encouraged. Collaborations among officers, physicians, therapists, and community health workers improves continuity of care. Stigma must be addressed to enhance communication and collaboration across professions.
Booty et al. 2023	Future research should analyze the effect of time credits have on extended‐release naltrexone initiation. Stigma and barriers to communication amongst those who work within probation and parole must be addressed to allow access to medication of opioid use disorder to be accessible to all who may require it.
Hunter et al. 2020	There were challenges for the program to apply to those with illicit substance charges because urine toxicology screening could not be conclusive for substances other than alcohol. Participants mentioned how those with first‐time offenses would benefit most considering having the option to have their record dismissed as a n incentive. Participation was low due to geographic constraints of the program and testing sites. The flexibility of officers and the developed protocol the department alleviated some of these implementation issues. Addressing state regulations that may hinder county level participation/implementation must be addressed to allow all individuals to have the opportunity to participate. There must be incentives for those to participate such as early dismissal from community supervision or deferred adjudication.
Kennedy et al. 2020	Strengthening awareness of evidence‐based practice and reducing bias/stigma may enhance initiation to collaborate between departments. Additional training within departments across staff such as judges and officers is needed to prevent barriers to treatment. Further, states that have Medicaid expansion have a more sustainable approach to providing MOUD; however, smaller or more local funding mechanisms should be sought after in areas without federal support.
Lasher and Stinson 2020	Core competencies for successful collaboration amongst community supervision and public health departments are: (1) values and ethics for interprofessional practice, (2) interprofessional communication, and (3) teams and teamwork. Future research should focus on specific areas of interest and go beyond an exploratory approach within a more diverse region and using larger samples. Further, addressing the criminogenic needs of clients in tandem with their health needs is crucial to improve outcomes.
Lichenstein et al. 2016	As more people with HIV are diverted to community supervision, more effort to make HIV treatment programs and testing available within community supervision departments is imperative. On‐site programming must involve inter and out agency collaboration to educate those working within the agency and their clients on stigmatizing conditions. Pilot testing is important to get foundational data with cash incentives to increase participation.
Matejkowski and Severson 2020	Training officers in common human goals and mental health recovery may advance shared decision making with individuals on community supervision with severe mental illness.
Myers et al. 2022	To facilitate programming, clients must feel autonomous in their decision making. Tactics such as slow and gradual implementation early in the criminal justice process, limiting police involvement, and using trauma‐informed and harm reduction approaches will improve implementation efforts.
Roskes and Feldman 1999	The major strength of this collaboration is the cooperation of the treatment and monitoring agencies with the overall goal of maintaining the individual on probation in the community. Further research is needed to confirm the effectiveness of the clinical model in reducing recidivism and retaining clients. Findings suggested a reduction in recidivism in those who participated in the program. results suggest successful adoption of the intervention and increased mental health engagement. In conclusions, among those on specialized mental health probation caseloads.
Van Deinse et al. 2020	Five key components emerged from the analysis: (1) meaningfully reduced caseload sizes and protected time; (2) officer ability to build rapport and individualize probation; (3) specialized training that is offered regularly to officers and administration such as chiefs; (4) regular case staffing and consultation; and (5) communication and collaboration with community‐based healthcare providers.
Van Deinse et al. 2022	Specialized mental health probation may be an effective strategy to program implementation for individuals with mental illness on community supervision. This study is the first randomized control trial (RCT) to examine the influence of programming on outcomes. The findings displayed there was no effect on probation violations, therefore, more research using RCT methods and large samples is needed on the factors that may contribute to violating the terms of ones’ probation.

3.2. Theme 1: Health Outcomes

Three studies focused on health outcomes, with subthemes which included outcomes related to substance use disorder and mental health (Bardin et al. 2022; Roskes and Feldman 1999; Van Deinse et al. 2022).

3.2.1. Substance Use Disorder

One study examined outcomes related to substance use disorder (Bardin et al. 2022). This study focused on female clients on probation in a gender‐specific program called Female Offenders Can Ultimately Succeed (FOCUS), which addressed substance use and mental illness (Bardin et al. 2022). Programming used learner‐focused self‐evaluation from the officers, which let clients choose if they wanted advice and follow‐up (Bardin et al. 2022). Out of the women referred by their officers to mental health (n = 79; 69.9%) or treatment of substance use disorder (n = 79; 69.9%), only 41 (36.3%) received care. The authors reported the number of participants who received health‐related services but did not report nor measure the efficacy of this type of programming or specific outcomes.

3.2.2. Mental Illness

Two studies reported on mental illness using community supervision engagement (Roskes and Feldman 1999; Van Deinse et al. 2022). Roskes and Feldman (1999) reported that the Axis I mental health diagnoses within their sample included seven participants (44%) with schizophrenia, three (19%) with major depression, five (31%) with bipolar disorder, and six (38%) with antisocial disorder. Other health disparities amongst the sample included three (19%) participants with diabetes, two (13%) with a seizure disorder, one (6%) with lung cancer, one (6%) with renal cancer, four (25%) people with hypertension, two (13%) with hepatitis C, and one (6%) with hypothyroidism. The study reported these health disparities as sample demographics and not as outcomes from involvement within community supervision's programming (Roskes and Feldman 1999).

Van Deinse et al. (2022) reported on participants with mental health disorders; however, they did not disclose the prevalence nor the outcome, but rather who began mental health action steps within their community supervision. Out of the sample, most participants referred to mental health resources mainly were (79.49%; n = 31) associated with specialty mental health probation caseloads compared to those with traditional programming (50%; n = 8) (X2 = 3.85, df = 1, p < 0.050).

3.3. Theme 2: Programming Issues

Nine studies evaluated programming issues regarding facilitators and barriers to addressing health outcomes (Bardin et al. 2022; Booty et al. 2023; Hunter et al. 2020; Kennedy et al. 2020; Lasher and Stinson 2020; Lichtenstein et al. 2016; Matejkowski and Severson 2020; Myers et al. 2022; Van Deinse et al. 2020).

3.3.1. Facilitators

Facilitators were extra support, collaboration, positive attitudes or empathy, incentives, funding, autonomy, and health literacy.

3.3.2. Extra Support

Two studies highlighted the importance of extra support as facilitators to programming within community supervision (Bardin et al. 2022; Van Deinse et al. 2020). Bardin et al. (2022) suggested that using female officers in gender‐specific programming for women may be beneficial in building rapport and proper support. In addition, officers in these studies had a reduced caseload (30–60 vs. 120+ clients) (Bardin et al. 2022) to permit more focused attention, which allowed effective implementation. Van Deinse et al. (2020) had comparable findings, with officers stating that a caseload less than 40 is crucial to have effective programming for clients needing support regarding their health. Several participants discussed more focused support from officers who had smaller caseloads enabled them to get support with housing, mental health services for their children, furniture for their homes, and navigating Child Protective Services and Drug Court adequately (Bardin et al. 2022). In addition, extra support from community health workers further aided in implementing client referrals and appointment reminders (Bardin et al. 2022).

3.3.3. Collaboration

Overall, three studies reported the need for collaboration amongst community supervision departments and public health services (Bardin et al. 2022; Lasher and Stinson 2020; Van Deinse et al. 2020). Effective programming involves individuals in community supervision and public health working collaboratively regarding their client's progress and health status using a non‐punitive approach (Bardin et al. 2022; Lasher and Stinson 2020). Demonstrating “proactiveness” and “empathy” helped strengthen these collaborations along with the use of technology such as texts and emails amongst individuals working within community supervision and public health and their clients (Lasher and Stinson 2020). Programming which handled special caseloads more effectively were those with frequent meetings and one‐on‐one mentorship between officers and their chiefs (Van Deinse et al. 2020).

Findings displayed effective collaboration requires establishing clear professional boundaries and roles between agencies associated with community supervision and public health (Lasher and Stinson 2020). One officer suggested asking questions regarding the preferences [or] ways others prefer to communicate as an effective strategy for promoting interdisciplinary collaboration with public health agencies (Lasher and Stinson 2020). Community supervision officers also suggested telling their clients to assist with getting their medical data to them to improve communication between their agency and public healthcare teams (Kennedy et al. 2020). Findings reflected in programs which urged clients to share their medical data helped to prevent misunderstandings by their officers regarding compliance with treatment for substance use and mental health and appropriate plans of care within community supervision (Kennedy et al. 2020). Moreover, additional personnel were discussed to improve collaboration (Bardin et al. 2022). For instance, having community health workers present at the community supervision department while people reported to their officers‐built rapport, reduced confusion, and enhanced communication between clients, officers, and public healthcare providers (Bardin et al. 2022).

Clients participating in programs with active collaboration across community supervision and public health shared experiences of feeling cared for and happy of having such specialized care by their physician and therapist (Bardin et al. 2022). Clients particularly voiced more ability to access care and support for medical and mental health issues while being on community supervision when they were placed in departments that worked collaboratively with public health providers (Bardin et al. 2022). In addition, participants reported liking their health care providers and community supervision officers working together so that all parties were aware for their treatment plan and state of their mental health which resulted in less write‐ups and more empathy while completing the terms of their probation (Bardin et al. 2022).

3.3.4. Positive Attitudes/Empathy

Four studies addressed positive attitudes and/or empathy as an integral component of effective program implementation (Booty et al. 2023; Kennedy et al. 2020; Lichtenstein et al. 2016; Van Deinse et al. 2020). Officers recognize that being more compassionate benefits everyone involved when working with clients in community supervision (Van Deinse et al. 2020). For example, positive attitudes of the officers toward a new medication that their program offered, extended‐release naltrexone (XR‐NT), improved implementation (Booty et al. 2023). For instance, there were officers reporting the acceptance of medication for opioid use disorder (MOUD) because it prevented their clients in having to supplement their prescriptions and/or self‐medicate, therefore, they were more prone to work with clients who were in treatment in a more positive way (Booty et al. 2023).

This finding was consistent with other studies that reported that an understanding versus punitive approach helped facilitate implementation and increase empathy among officers toward their clients (Kennedy et al. 2020; Lichtenstein et al. 2016; Van Deinse et al. 2020). Officers stated that the culture in community supervision has changed because they expect several setbacks with individuals during their road to recovery (Kennedy et al. 2020). Further, officers described that more education about disease processes helped reduce stigma and enhanced their client engagement especially around issues such as infectious disease (Lichtenstein et al. 2016; Van Deinse et al. 2020).

For example, one officer described that education helped them realize the link between client behavior and underlying health or developmental issues, which helped increase empathy noting those who may have a cognitive disability may be less responsive to their treatment plan or interaction with community supervision (Van Deinse et al. 2020). Another study described HIV education assisted in improving officer perceptions of managing clients with HIV (Lichtenstein et al. 2016). Community supervision departments found the more education about disease processes their officers had reduced fear regarding occupational exposure and less hesitation in working with clients whom were HIV positive (Lichtenstein et al. 2016).

3.4. Incentives

One study by Booty et al. (2023) discussed incentives such as time credits to have client supervision end early for program participation as a facilitator to implementation. In their program, they awarded clients who used a new extended‐release medication (XR‐NTX) for MOUD with time credit (Booty et al. 2023). By awarding clients, clinicians that worked collaboratively with community supervision noticed there was an increase in individuals wanting MOUD while on probation (Booty et al. 2023).

3.4.1. Individualization

Two studies discussed individualization, such as flexible times and locations for their clients to report to their officers and officers individually knowing clients’ needs, as strategies for successful implementation (Bardin et al. 2022; Van Deinse et al. 2020). In one study involving women who are mothers, participants reported to their officers in less populated areas that allowed children to accompany them and offered more flexible appointment times, which aided in program participation, retention, and satisfaction (Bardin et al. 2022). Another study recognized the importance of officers getting to know their clients’ situations to help tailor their programming (Van Deinse et al. 2020). Officer disclosed that understanding their clients’ daily activities and needs versus blaming them for not meeting milestones can be helpful (Van Deinse et al. 2020). Officers also disclosed that having conversations to identify the root of their clients’ issues assisted their department in having a preventative approach to collaboratively problem‐solve versus reacting or releasing them right away from probation (Van Deinse et al. 2020).

3.4.2. Funding

Another facilitator is funding from Medicaid or departmental, local, state, or federal grants (Kennedy et al. 2020). The most frequent grant mentioned was from the Substance Abuse and Mental Health Services Administration (SAMHSA) (Kennedy et al. 2020). Federal grants included State Targeted Response and State Opioid Response grants helped programming; however, Medicaid expansion was discussed as the funding mechanism that assisted the most in serving their clients’ needs while on community supervision (Kennedy et al. 2020).

3.4.3. Autonomy

Two studies acknowledged the importance of fostering clients’ autonomy within community supervision program implementation (Bardin et al. 2022; Myers et al. 2022). Bardin et al. (2022) discussed how programs worked well when officers inspired their clients to access medical services; however, not mandate this aspect of the program. Giving more autonomy to clients ultimately protected them from any punitive action from the probation department and enhanced autonomy and trust (Bardin et al. 2022). Further, Myers et al. (2022) suggested incremental or gradual engagement over time and across visits with peer counselors assisted with program implementation within community supervision. About 79% of the sample of officers stated this tactic worked for them and voiced more responsiveness from their clients while on community supervision when they gradually used ways to build trust (Myers et al. 2022).

3.4.4. Health Literacy

One study demonstrated higher levels of health literacy regarding treatment plans and disease processes is an effective way to facilitate programing amongst those working within community supervision and amongst their clients (Lichtenstein et al. 2016). Participants are more likely to be engaged in treatment, with 37% volunteering for lab work after learning that HIV‐related antiretroviral treatment (ART) can be lifesaving (Lichtenstein et al. 2016). Likewise, as previously reported, officers who had training in disease processes were more likely to engage in a more positive way with clients with stigmatizing conditions such as HIV (Lichtenstein et al. 2016)

3.4.5. Barriers

Barriers reported across the findings were lack of communication, lack of collaboration, stigma or bias, fear of police, financial or geographical restrictions, gaps in programming, and limited health literacy.

3.4.6. Lack of Communication

One study by Bardin et al. (2022) reported a lack of communication as a barrier to implementation, with varying experiences regarding the need for clarification of the community health workers’ role. Participants reported not being able to get ahold of their community health worker when they needed (Bardin et al. 2022). However, there were also barriers reported by community health workers which included frequent phone number changes or discontinuation, which impeded communication with clients on community supervision (Bardin et al. 2022). Community health workers advised to set appointments with individuals with substance use disorder in a timely manner because it may be hard to re‐contact them if there are gaps in communication (Bardin et al. 2022). Community health workers also suggested to never allow the client to think you do not care because showing empathy may save a life when working with individuals within community supervision (Bardin et al. 2022).

3.4.7. Lack of Collaboration

Two studies reported a lack of collaboration between community supervision and public health departments impeded program implementation (Booty et al. 2023; Kennedy et al. 2020). Booty et al. (2023) reported poor intra‐agency collaboration regarding buprenorphine and methadone for MOUD between community supervision and public health treatment programs for mental health and substance use disorders. Approximately 28% of the social service clinicians reported limited efficiency in obtaining required paperwork between the prison, probation, and community treatment programs for MOUD continuity of care (Booty et al. 2023). Clinicians stated clients being released from jail or prison often do not have documentation of the last time they received MOUD which prevents them from getting access to their medication after release heightening their risks to return to use (Booty et al. 2023).

Kennedy et al. (2020) had similar findings, describing differing views amongst providers regarding MOUD. Several participants expressed how providers would oppose treatment of substance use disorder and/or prefer one medication over alternative methods (Kennedy et al. 2020). The officers involved in this study mentioned that despite the inconsistency from the providers, their choices were limited in whom to refer their clients to, forcing them to try to find different strategies to navigate the officer‐client‐provider relationship (Kennedy et al. 2020). Finally, another barrier was the reluctance or complete omission of community supervision departments to partner with treatment clinics for MOUD, making it difficult for individuals needing treatment to access appropriate resources while on probation (Kennedy et al. 2020).

3.4.8. Stigma/Bias

Four studies noted how stigma or bias serve as barriers to implementation (Bardin et al. 2022; Booty et al. 2023; Kennedy et al. 2020; Lichtenstein et al. 2016). One study found that stigma regarding different types of MOUD amongst officers delayed appropriate care (Booty et al. 2023). For instance, clinicians stated that they experienced officers telling clients they were not allowed to use suboxone while on community supervision despite their treatment plan with their healthcare provider (Booty et al. 2023).

One study also found bias in the way judges in the court system chose treatment of substance use disorder, such as methadone, or which providers to refer clients to (Kennedy et al. 2020). Participants also described experiencing stigma while accessing health care in the clinics that served the specialized programming within community supervision which caused distress and feelings of distress (Bardin et al. 2022). For example, a participant recounted how a receptionist within the healthcare department she was assigned to for treatment for substance use disorder, brought up her medical condition openly which caused her to feel anxious (Bardin et al. 2022). In another study, an officer reported that stigma may interfere with the way officers approach managing their caseload ((Kennedy et al. 2020). For instance, he expressed witnessing officers using drug tests to easily and quickly get clients off their caseload (Kennedy et al. 2020). Likewise, others reported fear of stigma kept individuals from seeking healthcare such as HIV treatment while on community supervision (Lichtenstein et al. 2016).

3.4.9. Fear of Police

A fear of police amongst those on community supervision hindered successful completion of probation. In the study by Myers et al. (2022), 47% of their clients reported fear of police involvement and did not like the strict rules regarding smoking, which restricted program participation and implementation for substance use disorder. One officer acknowledged that many of their clients come from environments where they experienced intergenerational trauma and incarceration which made them reluctant to trust programming within community supervision and their officers (Myers et al. 2022).

3.4.10. Financial or Geographic Restrictions

Other barriers reported in the findings were financial and geographical restrictions. Hunter et al. (2020) reported clients’ inadequate financial means and the distance of testing sites as barriers. Officers reported that many clients lived out of town which prevented them in making meetings consistently while on community supervision (Hunter et al. 2020). Further, officers recognized that many of their clients did not have access to transportation which further jeopardized those who lived far from the community supervision department to meet their requirements of probation (Hunter et al. 2020).

3.4.11. Gaps in Programming

Two studies reported gaps in programming that hindered implementation (Hunter et al. 2020; Kennedy et al. 2020). One study reported that offenses such as driving under the influence (DUI) or alcohol‐related charges were not included in the treatment program for substance use disorder (Kennedy et al. 2020). Officers within community supervision suggested that including everyone in treatment for substance use disorder including those with histories of alcohol misuse, may reduce recidivism and enhance implementation (Kennedy et al. 2020).

Hunter et al. (2020) reported that not mandating program participation as part of people's final sentencing decreased the incentive to participate in treatment. Further, they reported that participants felt like it was more of a punishment than a rehabilitative technique by the department which deterred clients from seeking treatment for substance use disorder (Hunter et al. 2020). Another issue reported by Kennedy et al. (2020) identified that restrictions in policies within residential treatment centers prevented adequate programming for their clients while on community supervision. For instance, individuals required to have MOUD in the community were denied that level of care due to residential agencies not allowing MOUD on their site (Kennedy et al. 2020).

Limited Health Literacy

Finally, findings suggested that limited health literacy amongst clients within community supervision hindered program implementation (Bardin et al. 2022). Clients who did not understand the roles of the individuals who work within community supervision spaces subdued the continuity of care (Bardin et al. 2022). Further, clients unaware of how to address symptoms and take the initiative in managing their health sometimes result in return‐to‐use or feelings of inadequate support while in community supervision (Bardin et al. 2022).

4. Discussion

Overall, very scarce empirical evidence evaluating health outcomes for individuals on community supervision exists; this is a critical gap in research, as research suggests that criminal justice system involvement is associated with higher rates of physical illness, mental illness, and substance use (Hawks et al. 2020; Winkelman et al. 2020). As these risk factors are associated with an increased likelihood of probation or parole revocation and recidivism, community supervision agencies must use effective treatment interventions that ideally work in collaboration with other organizations such as public health agencies.

Recently, community supervision has shifted from focusing on surveillance and enforcement toward a more rehabilitative and restorative approach (Bourgon and Gutierrez 2012; Marder and Rossner 2021). The movement to adopt evidence‐based practices that reduce recidivism has led to increased coordination across correctional and public health systems, such as treatment of substance use and mental health disorders (Marder and Rossner 2021; Vaughn et al. 2012). Cross‐system collaboration is necessary to reduce social and health‐related disparities, as those on community supervision are often among the most marginalized communities that face a higher risk of poor health outcomes (Fernandes 2020; Semenza and Link 2019). Community supervision can serve as an intervention that can reduce adverse health risks and increase the likelihood of connecting someone to services, but it also operates under a philosophy of coercion and control, which can limit its effectiveness (Huebner and Shannon 2022; Phelps 2020; Phelps et al. 2022). Thus, community supervision agencies must work with community‐based healthcare systems to provide support and services for vulnerable individuals.

As highlighted in our review, one barrier to collaboration across systems is the stigma associated with providing non‐punitive responses, such as treatment of substance use and mental health disorder, which parallels prior research (Crawford et al. 2022; Livingston 2020). Therefore, it is necessary to provide substantive and culturally competent training to improve the implementation of evidence‐based practices in community supervision settings (Viglione et al. 2020). For example, one study found that training, in addition to an organizational linkage intervention, increased positive attitudes toward referring clients to treatment of substance use disorder by community supervision officers (Friedmann et al. 2012). Similarly, in a test of the effectiveness of using a health navigator (e.g., a person with experience working with both community supervision and in a medical environment), a referral to a primary care provider by a health navigator increased the proportion of individuals accessing healthcare services (O'Connell et al. 2020). Collectively, these studies demonstrate that collaboration between community supervision and public healthcare systems can increase the likelihood that individuals receive services that can reduce health‐related and criminogenic risk factors.

Moreover, the findings highlight that facilitators were Medicaid coverage or grants from the local, state, or federal level to assist those with opioid use disorders to obtain treatment. In addition, the findings pointed to how crucial effective communication between health providers and those within criminal justice spaces is imperative to stop inessential arrest. Often, people who need rehabilitation are caught into repeated recidivism due to untreated substance use or mental health disorders (Bell et al. 2020; Lawson et al. 2024). A helpful resource to better serve those coming out of incarceration needing services and support is the Sequential Intercept Model (SIM) by the Substance Abuse Mental Health and Mental Health Administration (SAMSHA) (Substance Abuse and Mental Health Services Administration 2024). The SIM provides a map of how those with mental health and substance use disorders become with the criminal justice system and gives guidance on addressing resource and treatment gaps to prevent unnecessary arrest and detention of those who commit nonviolent offenses and would benefit from mental health services (Substance Abuse and Mental Health Services Administration 2024).

In addition, in 2023, the Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), released updated standards providing guidance for states to apply for Medicaid funding to demonstrate the value of healthcare coverage for individual upon release from detention (Justice Community Opioid Innovation Network Coordination and Translation Center 2024). Pre‐release services prison and jail systems can put in place include: (1) case management for physical and behavioral health to connect individuals to services, (2) MAT, and a (3) thirty‐day supply of medications prescribed to those while incarcerated (Justice Community Opioid Innovation Network Coordination and Translation Center 2024).

4.1. Recommendations for Future Research

Our findings discussed health outcomes broadly without investigating the efficacy of programming nor tracking the prevalence of health outcomes amongst those on community supervision. Further, it is concerning that we found only one study that focused on gender‐specific programming and outcomes of childbearing women. Women of childbearing age are the fastest‐growing population to encounter mass incarceration and are more likely to be placed on community supervision (Heimer et al. 2023; Phelps et al. 2022).

Women within the criminal justice system have higher morbidity and mortality compared to those without criminal justice involvement (Karlsson and Zielinski 2020; Sufrin et al. 2019, Sufrin et al. 2020). Prevalent health disparities in this population include cardiovascular disease, pre‐eclampsia/eclampsia diabetes, gestational preterm birth, small for gestational age, postpartum hemorrhage, postpartum depression, substance use disorder, and violence (Karlsson and Zielinski 2020; Sufrin et al. 2020, Sufrin et al. 2019). In addition, incarceration and arrest exacerbate these health disparities (Kajeepeta et al. 2021; Massoglia and Remster 2019). Considering maternal–child morbidity and mortality are growing at a concerning rate in the United States (Chinn et al. 2020; Glazer and Howell 2021), more research is needed to investigate health outcomes and efficacy of programming for childbearing women, their children, and their families. Therefore, we recommend future directions for research to utilize larger more generalizable samples that utilize designs that have more rigor such as randomized control trials are needed to examine efficacy of programming and to evaluate health outcomes of those within community supervision.

We also recommend more research that focuses on health‐related outcomes, interventions, and programming specific to women of childbearing age who are on community supervision to alleviate health disparities. Possible solutions to bridging care of populations coming out of incarceration are scalable solutions such as tailored mobile health apps that can be introduced on admission to prison, jail, or residential treatment and follow clients to the community setting during re‐entry(Anderson‐Lewis et al. 2018; Carrandi et al. 2023; Gustafson et al. 2024). Finally, holistic approaches to in‐person social support such as full‐spectrum doulas. Full‐spectrum doulas are trained professionals around culturally appropriate peer support for those during pregnancy, childbirth, postpartum and beyond which may assist in mitigating maternal morbidity and mortality in pregnant and birthing individuals following incarceration (Gannon et al. 2022; Haiman et al. 2024; Lindsey et al. 2023; Sparks 2023). Birthing and parenting individuals on community supervision may benefit from full‐spectrum doula support around issues such as pregnancy planning or prevention, violence prevention and reporting, bonding, parenting, coping, and stress reduction (Gannon et al. 2022; Haiman et al. 2024; Lindsey et al. 2023; Sparks 2023).

4.2. Implications for Public Health Nursing

Community supervision departments should implement preventative practices to include services and collaborative approaches with public health nurses that address their clients’ social determinants of health (Marder and Rossner 2021). These types of programming within community supervision or parole departments may include initiatives that work with public health nurses such as (1) strengthening shared decision‐making and dialogue amongst team members, including clients, (2) training in harm reduction techniques versus punitive punishment, and/or (3) fostering therapeutic relationships among colleagues within their department(s) and across disciplines, clients, and the broader community (Marder and Rossner 2021). Further, by utilizing these health models, a more comprehensive approach by utilizing public health nurses to address the dynamic health‐related needs of those on community supervision can become an essential integrated aspect of programming and intervention implementation in probation and parole departments.

4.3. Limitations

It is common for scoping reviews to have limitations. Apparent limitations of this scoping review may involve the bias of the reviewers or the accidental exclusion of articles. The authors decreased bias by using Rayyan, having two reviewers work independently and blindly, and utilizing a third reviewer as a tiebreaker to address conflicts. As more research regarding health outcomes emerges in the community supervision arena, we recommend a more rigorous and robust analysis, such as a meta‐analysis, will be necessary to understand better how engagement between community supervision and public health affects health outcomes.

5. Conclusion

The findings of this scoping review emphasize the extent and gap in literature related to utilizing community supervision engagement to examine the health outcomes of people with criminal justice system oversight, as well as the facilitators and barriers to implementing the current strategies. The findings are scarce, which limits the ability to make meaningful assumptions. One study utilized a randomized control trial methodology to evaluate the effectiveness of programming on health outcomes. Although the findings suggest promise in enhanced program engagement, continuity of care, and possible reduction in recidivism, more rigorous research is warranted to measure the effectiveness of community supervision engagement with public health services to improve health outcomes. Finally, considering that women of childbearing age are most likely to be deferred to community supervision and maternal and child morbidity and mortality is an ever‐growing public health crisis, more investigation is needed specific to this population.

Author Contributions

Study Concept and Design: A.D.C., J.M. Data Collection/Management: R.H., M.H., J.R., A.D.C. Data Analysis: A.D.C., H.Z., S.B., J.M. Drafting of the Article: A.D.C., H.Z., S.B., J.M. Editing and Revision: A.D.C., J.M.

Conflicts of Interest

All authors have approved the manuscript and report no conflicts of interest,

Supporting information

Supporting Table 1: Search translation.

Crawford, A. D. , Zettler H., Braddy S., et al. 2025. “Community Supervision Engagement to Examine Health Outcomes: A Scoping Review.” Public Health Nursing 42, no. 5: 42, 1746–1760. 10.1111/phn.13577

Data Availability Statement

The data that supports the findings of this study are available in the supplementary material of this article.