“Overlapping and intersecting challenges”: Parent and provider perspectives on youth adversity during community reentry after incarceration

Abstract

Parents and health and service providers play key roles in supporting youth during reentry, defined as the six-month period following release from incarceration. During reentry, parents and providers help youth overcome various challenges, as well as address high medical and behavioral healthcare needs. We used thematic analysis to understand parent and provider perspectives on youth responses to adversity during reentry as it relates to youths’ health and wellbeing. In total, we examined 52 interviews conducted with 34 parents of youth undergoing reentry. Parents participated in longitudinal interviews, with the first interview occurring one month after youth release and follow-up interviews at three and six months post-release. We also examined 20 interviews done with providers who serve youth undergoing reentry. The sample of health and service providers included medical and behavioral health providers in community and correctional health settings, as well as leaders in education, juvenile justice, and correctional healthcare. Interviews were conducted in Los Angeles County between 2016 and 2018. In our analyses, we identified themes on the types of adversity youth experience during reentry, as well as youths’ health-related behavioral responses to the adversity. Parents and providers shared that: 1) youth face challenges tied to the reentry process; 2) youth return to ongoing challenges in their environments upon reentry; 3) youth engage in health-promoting behavioral responses to adversity; and 4) youth engage in health-detracting behavioral responses to adversity. Parent and provider perspectives suggest a need to expand systems of support to facilitate health-promoting responses to adversity during reentry in order to improve youths’ long-term health and reentry success.

1. Introduction

Justice-involved youth encounter substantial adversity throughout their childhood and adolescence that deeply impacts their health and development (Barnert et al., 2016). Bronfenbrenner’s (1979) social ecological theory provides a useful framework for conceptualizing the various layers of adversity experienced by justice-involved youth. Bronfenbrenner’s theory posits that youth are embedded within several interrelated contexts and systems that impact their wellbeing and development. With justice-involved youth, a social ecological framework helps highlight how stressors and adversities across varying levels shape their health and development, as justice-involved youth face multiple barriers to health and wellbeing at every level (Johns, 2018; Johns et al., 2017).

1.1. Microsystem challenges

For youth in the juvenile justice system, profound challenges often come early within their individual and immediate context or “microsystem” (Bronfenbrenner, 1979). Justice-involved youth experience disproportionately high rates of adverse childhood experiences (ACEs); 50% of justice-involved youth have experienced four or more ACEs, compared to 13% of non-justice-involved youth. Most commonly, justice-involved youth experience family violence, parent separation, and household member incarceration (Baglivio et al., 2014). The high rate of ACE exposure seen in justice-involved youth likely contributes to the high prevalence of psychiatric disorders in the United States (U.S.) juvenile justice population—three of four incarcerated youth have at least one psychiatric disorder (Owen & Wallace, 2020; Teplin et al., 2002). Common psychiatric challenges among justice-involved youth, such as depression, anxiety, post-traumatic stress disorder, suicidality, and substance use disorders, may all link to prior trauma exposure (Abram et al., 2008; Stokes et al., 2015; Teplin et al., 2002). In addition to the acute distress inherent to childhood exposure to adverse experiences, ACEs have been associated with significant morbidity into adulthood (Felitti et al., 1998; Gilbert et al., 2015), including adult depression (Chapman et al., 2004) and engagement in risky behaviors such as substance use and other health-detracting behaviors (Bellis et al., 2014; Grasso et al., 2013; Ramiro et al., 2010). Further, ACE exposure has been linked to lower social standing as an adult (Metzler et al., 2017). As such, early microsystem adversity experienced by justice-involved youth in their immediate contexts seems to ripple across the life course.

1.2. Macrosystem challenges

Adversity in the larger cultural, economic, and sociopolitical context or “macrosystem” (Bronfenbrenner, 1979) is especially relevant for justice-involved youth, as adversity in the form of systemic racism further impacts their health (Duarte et al., 2020; Laub, 2014). Not only does the U.S. detain its adolescents at the highest rate among developed nations, 336 per 100,000 youth (Hazel, 2008), it also disproportionately arrests and detains African American and Latinx youth (Owen & Wallace, 2020; Sickmund et al., 2019). In 2010, the U.S. detained Black youth at a rate of 606 per 100,000 and Latinx youth at a rate of 228 per 100,000, compared to 128 per 100,000 for White youth. On average, youth who are incarcerated are in confinement for three to four months (Sickmund & Puzzanchera, 2014), often for non-violent or non-serious offenses (Puzzanchera, 2014). Moreover, racial disparities are further widened by the criminal justice system’s differential treatment of Black and Latinx youth at each stage along the carceral continuum (Kakade et al., 2012; Puzzanchera et al., 2016; Starr & Rehavi, 2013). In addition to disproportionate rates of arrests, Black and Latinx youth are more likely to be committed to a secure facility and receive harsher sentencing (Rovner, 2016; Starr & Rehavi, 2013). Given that incarceration itself can negatively impact health (Barnert et al., 2017), as can the reentry period after release (Barnert, Lopez, & Chung, 2020; Freudenberg et al., 2005), incarceration must be recognized as a negative determinant of health that disproportionately affects Black and Latinx youth. In addition, other racial inequities in areas such as poverty, education, and healthcare access also relate to disparities in health outcomes and risk behaviors (Centers for Disease Control and Prevention, 2020), which exacerbate incarceration risk and intensify reentry challenges (Barnert et al., 2016). Thus, many justice-involved youth and their families cope with significant adversity at the macrosystem level that is well-understood to increase their risk for justice involvement and poor health outcomes.

1.3. Reentry as a challenge and opportunity

During the reentry period, youth and their parents must manage mounting stress as they navigate the difficult transition home from incarceration, encountering challenges and opportunities at multiple social-ecological levels (Johns, 2018; Johns et al., 2017). The term reentry typically refers to the six-month period following incarceration when youth return to their homes and communities (Altschuler & Brash, 2004). Upon this return, youth contend with several challenges within their microsystems (e.g., home, school, and neighborhood) as well as barriers in the connections between their various microsystems, also known as the “mesosystem” (Bronfenbrenner, 1979). Many youth return to environments and settings conducive to risky behaviors (Altschuler & Brash, 2004; Fehon et al., 2001). Specifically, the availability of illicit substances and proximity to neighborhood violence during transitions home after incarceration can prove especially difficult for justice-involved youth in the community working towards desistance (Crouch et al., 2000; Phillips & Lindsay, 2011). Moreover, youth must manage this difficult transition while simultaneously juggling new responsibilities; many justice-involved youth are asked by probation and the courts to comply with multiple conditions and requirements that have been shown to be overwhelming, yet ineffective in curbing recidivism (Mendel, 2018).

Though justice-involved individuals generally report optimism at the outset of reentry (Phillips & Lindsay, 2011), high rates of recidivism signal serious vulnerability, with estimates showing that between 18 and 46 percent of youth return to incarceration within two years of release (Mendel, 2011). In a mixed methods study, Phillips and Lindsay (2011) outlined the vulnerability of reentry, delineating how barriers across varying systems might result in recidivism. Phillips and Lindsay (2011) found that justice-involved individuals experience optimism upon beginning reentry but eventually encounter various difficulties during the reentry process. To cope with the challenges of reentry, these same individuals engage in maladaptive coping that then leads to additional struggles and eventually recidivism. As such, the management of inevitable challenges and barriers during the vulnerable period of reentry may play an important role in facilitating the long-term health and success of justice-involved individuals.

Some of the inevitable challenges of reentry may relate to the existing needs youth bring into their interactions with different systems and contexts. Challenges related to unmet medical and behavioral healthcare needs have been linked to worse reentry outcomes (Piquero et al., 2013), and youth undergoing reentry show high unmet healthcare needs (Annie E. Casey Foundation, 2013). For example, compared to their non-justice-involved peers, justice-involved youth experience higher rates of sexually transmitted infections, substance use disorders, and suicidality (Committee on Adolescence, 2011). However, despite high healthcare needs, many youth lack adequate access to healthcare (Golzari et al., 2008; Golzari & Kuo, 2013). At the same time, maintaining and providing healthcare and support during reentry has been shown to reduce recidivism and improve reentry outcomes (Bullis et al., 2004; Burns et al., 2000; Chung et al., 2007). For example, engagement in post-release support has been associated with a reduced likelihood of continued justice involvement (Chung et al., 2007) and an increased likelihood of educational and vocational engagement (Bullis et al., 2004). Further, strength-based approaches that facilitate supportive relationships across youths’ microsystems and mesosystems have been effective in promoting desistance (Johns, 2018; Johns et al., 2017). Despite the promise of reentry services, justice-involved youth typically lack adequate support during this critical period (Hammett et al., 2001). Additionally, youth and their families often face barriers during reentry that leave them unable to access existing supports. Thus, the reentry period is a key window to provide support in order to promote youths’ health and wellbeing and disrupt cycles of incarceration (Barnert, Lopez, & Chung, 2020; Barnert, Lopez, Pettway, et al., 2020; Udell et al., 2017).

1.4. Parent perspectives on youth reentry

Despite the importance of reentry on health and wellbeing, the current literature on youth reentry seldom explores the health and healthcare needs of youth during this period (Barnert, Abrams, et al., 2020). Moreover, prior research suggests that supportive relationships across youths’ various microsystems can mitigate other harmful interactions and barriers (Johns, 2018; Johns et al., 2017). Previous work suggests that parent engagement can improve treatment outcomes in behavioral healthcare (Haine-Schlagel & Walsh, 2015; Hoagwood, 2005) and increase healthcare utilization for youth undergoing reentry (Barnert, Lopez, Pettway, et al., 2020), which is notable given justice-involved youths’ high healthcare needs (Annie E. Casey Foundation, 2013; Committee on Adolescence, 2011). Yet the current literature on youth reentry and health scarcely reports parent perspectives (Barnert, Lopez, Pettway, et al., 2020; Udell et al., 2017), indicating an important gap in the extant literature.

The limited research on parent perspectives on youth reentry supports the importance of understanding parent perspectives. In a mixed methods study, Barnert, Lopez, Pettway, et al. (2020) found that, during reentry, parents motivate youth to seek treatment and support by communicating values, enforcing rules, and fostering youth independence. Parents also play an instrumental role in helping youth overcome various barriers to healthcare utilization. For example, parents help youth navigate complex systems to obtain health insurance after incarceration and schedule health appointments. In addition, parents provide support in the form of transportation and accompaniment for appointments (Barnert, Lopez, Pettway, et al., 2020). Interestingly, parent perspectives have been shown to diverge from youth perspectives in key areas (Trout et al., 2014). First, youth report higher confidence in their ability to handle the difficult process of reentry, while parents are more likely to view youth as less prepared. As such, relative to youth, parents are more likely to report that youth required support during reentry. Parents also report a higher willingness to participate in aftercare programs, compared to youth (Trout et al., 2014). Given that parents play an important role in supporting youth during reentry in overcoming barriers to care (Barnert, Lopez, Pettway, et al., 2020) and that parent perceptions of reentry service needs differ from youth (Trout et al., 2014), parent perspectives warrant further exploration.

1.5. Provider perspectives on youth reentry

For justice-involved youth, with their high medical and behavioral healthcare needs (Committee on Adolescence, 2011), supportive relationships likely come in the form of health and service providers who help youth address healthcare needs during reentry (e.g., therapists, physicians, educators, case workers, and correctional staff). Further, adequate intervention and support during the reentry period has been shown to reduce recidivism and improve youths’ health outcomes (Bullis et al., 2004; Burns et al., 2000; Chung et al., 2007). However, despite the important role of health and service providers, the current literature on youth reentry and health rarely investigates provider perspectives (Barnert, Abrams, et al., 2020). Health and service providers, with their unique mix of direct service experience and domain expertise, can likely share invaluable insight on how to best help youth navigate the precarious process of reentry.

1.6. Current study

Justice-involved youth have high healthcare needs (Committee on Adolescence, 2011; Golzari et al., 2008; Golzari & Kuo, 2013), face adversity in the various social-ecological systems they are embedded in (Baglivio et al., 2014; Bronfenbrenner, 1979; Sickmund & Puzzanchera, 2014), and are vulnerable to recidivism (Mendel, 2011; Phillips & Lindsay, 2011) and poor downstream health outcomes (Barnert et al., 2017). However, adequate reentry support (Bullis et al., 2004; Burns et al., 2000; Chung et al., 2007) and supportive relationships (Johns, 2018; Johns et al., 2017) have been show to help youth overcome reentry adversity and promote positive outcomes. For youth undergoing reentry, positive relationships and support are most likely to come from health and service providers who help youth address high unmet healthcare needs (Annie E. Casey Foundation, 2013; Committee on Adolescence, 2011) and parents who help youth connect with care (Barnert, Lopez, Pettway, et al., 2020). Thus, it is imperative to understand parent and provider perspectives on adversity faced by youth undergoing reentry, as they can inform interventions and approaches to support youth health and promote successful reentry. Therefore, we sought to understand parent and provider perspectives on youth adversity and their health-related behavioral responses during the reentry period.

2. Methods

2.1. Design and setting

For this in-depth qualitative study, we analyzed semi-structured interviews collected as part of a larger mixed methods study that partnered with the Los Angeles County juvenile justice system, the largest county-run juvenile justice system in the U.S. (Barnert, Abrams, et al., 2020; Barnert, Lopez, Pettway et al., 2020). All procedures were approved by our university institutional review board and the Los Angeles County Juvenile Court.

The larger mixed methods study recruited youth released from juvenile incarceration between November 2016 and March 2018. Though the larger study did not purposely sample Black and Latinx individuals, our sample was exclusively composed of Black and Latinx families. All participants were recruited from Los Angeles County, California. For additional details about recruitment and youth sample see Barnert, Lopez, Pettway, et al. (2020). Forty-four percent of youth invited to participate by the study team agreed to participate, resulting in a response rate acceptable and common for research on justice-involved youth (Abrams, 2010). As part of the larger study, youth completed close-ended surveys, and youth and their parents/caregivers were invited to complete longitudinal, semi-structured interviews discussing youths’ healthcare needs and access during reentry (see Appendices A and B for baseline interview guide and follow-up interview guide, respectively). The first interview occurred one-month after youth release, while follow-up occurred at three and six months following their child’s release. The larger study also invited reentry health and service providers to participate in a single semi-structured interview to discuss their views on youths’ health needs and barriers to healthcare for youth undergoing reentry (see Appendix C for interview guide).

2.2. Participants and data collection

To optimize quality of data and participant experiences with the study, a diverse group of researchers, including two Latinx women, two Black women, and one East Asian American woman, conducted interviews. Whenever possible, the larger study’s team matched participants and interviewers by race/ethnicity in an effort to facilitate trust and rapport (i.e., Latinx researchers interviewed Latinx participants, and Black researchers interviewed Black participants). The Latinx interviewers were native Spanish speakers and conducted all contact with Spanish-speaking participants. The East Asian American interviewer conducted provider interviews. When recruiting for interviews, the larger study applied two distinct purposive sampling frames to parents/ caregivers and providers. The approach is summarized below, and additional details are available in Barnert, Lopez, Pettway, et al. (2020) and Barnert, Abrams, et al. (2020).

2.2.1. Approach to parent interviews

Families originally learned about the larger study through flyers given to youth when exiting juvenile incarceration. During the enrollment period, county probation also provided contact information for recently-released youth. The research team then contacted listed families to invite them to participate in the study. When interacting with potential participants, the study team articulated that participation decisions carried no impact on youths’ standing or status with probation, court, or service providers. For feasibility, consent was completed over the telephone.

The parents/caregivers of youth who agreed to interviews were also invited to participate in longitudinal semi-structured interviews to discuss their child’s healthcare needs and experiences accessing healthcare during reentry. Parent/caregiver eligibility among the recruitment pool of youth recently released from Los Angeles County incarceration during the study enrollment period included English or Spanish fluency and ability to verbally consent to participation. After initially connecting with mostly mothers, the study team purposively oversampled fathers. Parent/caregiver interviews occurred in-person or via telephone based on participant preference. Researchers also allowed participants to select the time, location, and language (English or Spanish) of the interviews. Nearly half of parent/caregiver interviews were conducted in Spanish (16 of 34 parents/caregivers). All parent/ caregiver interviews were conducted in a private location without youth present and lasted approximately 45 min. Researchers audio-recorded interviews and used a transcription service to transcribe the audio files. For each completed interview, parent/caregiver participants received a $30 gift card.

Thirty-four parents/caregivers participated in the longitudinal semi-structured interviews, resulting in 52 total parent/caregiver interviews after attrition. All thirty-four parent/caregiver participants completed a baseline interview; 13 completed the three-month follow-up interview; and five completed the six-month follow-up interview. Of the 34 participants, mothers (28) made up a larger portion of the sample, compared to fathers (5) and other caregivers (1). In our sample, “other caregiver” exclusively referred to grandmother. Mothers included one adoptive mother, and fathers included one stepfather. For simplicity, we will herein use the term “parent” when referring to parents and caregivers. Our sample included two mother-father pairs (four parents) with a shared youth. Both mother-father pairs completed only a baseline interview; thus, four interviews are from parents with a common child. Additional sociodemographic data are available for 23 of the 34 parents, as the youth of these 23 parents completed the quantitative component of the larger study. Table 1 summarizes sociodemographic characteristics of these 23 parents, based on responses from their children who reported sociodemographic information via survey. Most parents were identified by their youth as Hispanic/Latinx (56.5%) or African American (34.7%). Of the parents with youth-reported sociodemographic information, 47.8% were born in the U.S., 39.1% in Mexico, and 12.9% in Central America. About one-third (30.4%) of parents were the head of a single-parent household. The remaining 11 parents’ youth did not complete a quantitative survey.

Table 1.

Parent sociodemographic information.

	N = 23 Parentsa	%
Race/Ethnicity
Hispanic/Latinx	13	56.5
African American	8	34.8
Missing	2	8.7
Interviewee Country of Origin
United States	11	47.8
Mexico	9	39.1
Chile	1	4.3
El Salvador	1	4.3
Guatemala	1	4.3
Language Spoken at Home
Only English	11	47.8
Both Languages Equally	5	17.4
More English	4	21.7
More Non-English	2	8.7
Only Spanish	1	4.3
Household Structure
Two Parents	16	69.6
Single Parent	7	30.4

Note.

^aItems are derived from youth surveys where 23 of the 34 parent interviewees had a child who completed a survey. For Household Structure, “Two Parents” responses include biological and non-biological parents.

2.2.2. Approach to provider interviews

To reach providers, researchers emailed heath and service providers and leaders in both community and correctional healthcare in Los Angeles County. The initial sample was first identified by the larger study team based on being known contacts with expertise on youth reentry and health. The sample was subsequently expanded using snowball sampling in order to include representatives from multiple provider roles relevant to youth health and reentry. Provider roles included administrators and direct providers in correctional health, community pediatrics, reproductive health, behavioral health, and substance use treatment, as well as leadership in education and juvenile justice. Of the 20 providers, six worked in community healthcare (including medical, behavioral, and reproductive health), four worked in correctional behavioral healthcare, and four worked in correctional medical healthcare. As our sample of providers also included leaders and stakeholders in areas relevant to justice-involved youth, the remainder of the sample included two judicial representatives, two educational representatives, and one healthcare professional with an organization overseeing correctional healthcare quality nationally. All providers who received an email invitation either agreed to partake in the study or nominated someone else within their organization. Twenty providers participated in a single semi-structured interview sharing their views on youth healthcare needs and access during reentry, as well as recommendations for improving healthcare access for youth during reentry (Appendix C). All providers participated via telephone, and interviews lasted between 30 and 45 min. As with parent interviews, researchers recorded provider interviews and used a transcription service to transcribe the audio into text.

2.3. Analyses

We conducted thematic analysis of parent and provider interviews (Braun & Clarke, 2006) using Dedoose software. Two members of our team coded all interviews. Our two coders included: 1) a Southeast Asian American man with previous clinical experience serving justice-involved adolescents and at-risk youth in community mental health settings and 2) a Latinx woman who is a native Spanish speaker and from an underserved community in Los Angeles. In addition, our team included: 1) the principal investigator of the larger mixed methods study, a multiracial woman pediatrician who is a Native Spanish speaker with extensive experience conducting qualitative research on the health of youth during reentry, 2) a Latinx woman clinical psychologist who is a native Spanish speaker, 3) a White male physician, and 4) an East Asian American male medical student with previous experience working with justice-involved youth in a non-clinical context.

First, two coders open-coded interviews to identify text relevant to youth adversity and health during reentry. In the open-coding process, we applied a broad definition of health that includes medical and behavioral health (World Health Organization, n.d.). To conceptualize adversity, we utilized the definition of adversity from Cohen et al. (2019): “events that are threats to one’s social status, self-esteem, identity, or physical wellbeing” (p. 578). During the open-coding process, our two coders met regularly with the larger team to define and organize codes into a preliminary codebook. Codebook development meetings always included the two coders and the senior member from our study team. Other team members participated in monthly meetings, and provided additional input on codebook development as needed.

After developing the initial codebook, our team then performed iterative coding until reaching consensus on the codebook. Next, our two coders double-coded a set of transcripts to check for mutual understanding. After, both coders met with the larger team to discuss preliminary findings and reach a consensus on the codebook, as well as all coded text. Preliminary findings were shared in regular team meetings, during which all coding disagreements were resolved. The final codebook captured all instances in which parents and providers discussed past and present adversity experienced by youth undergoing reentry. The same codebook was used for parent and provider interviews. Text could simultaneously be coded for multiple themes when appropriate. Spanish interviews were coded by a native Spanish speaker who translated exemplar quotes and contributed to regular team meetings that included other native Spanish speakers.

After coding all interviews, we extrapolated codes into themes and sub-themes. When organizing codes related to adversity, we separated adversity into 1) reentry adversity (i.e., challenges tied to the reentry process), and 2) ongoing adversity (i.e., challenges generally independent of the reentry process). Adversity sub-themes related to structural barriers follow an identical organization within their respective themes. We sorted themes related to youth responses to adversity into health-detracting versus health-promoting behaviors. We defined health-detracting or risky responses as any behavior parents and providers perceived as adversely affecting youth health or increasing the likelihood of recidivism. Conversely, we defined health-promoting responses as any behavior parents and providers perceived as benefitting youth health or reducing the likelihood of recidivism. While our focus was on thematic analysis, we calculated the number of participants who reported each theme or sub-theme at least once during interviews (Tables 2–5).

Table 2.

Parent and provider perspectives on reentry-specific adversity.

Reentry Challenge	Percent Reported	Parent and Provider Quotes
		Re-Adjusting to Expectations in the Home:
Adjustment to Home	Parents 20.5%	Well because she spent a lot of time out of the house and well to come back again, adapt to the rules of the house and to adapt to her sisters as well. – Mother of 17-year-old female
		Loss of Structure Provided by Detention:
	Providers 10.0%	I think it’s challenging to go from a structured environment back into whatever kind of environment they were in before. – Community Healthcare Provider
		Pressure of Court Supervision:
New Responsibilities	Parents 17.6%	Because they go home, but they’re still under a lot of pressure because they feel like they’re still being watched by so many people. - Grandmother of 16-year-old male
		Youth Prioritize Reentry Tasks Before Health:
	Providers 10.0%	They often have a lot of other issues, such as where they’re going to live, where they’re going to go to school or not go to school… which might get in the [way of healthcare appointments]. – Correctional Healthcare Provider
		Disruption in Public Insurance Coverage:
Structural Barriers to Reentry	Parents 47.0%	I am trying to find out about his Medi-Cal because they screwed that all up. I don’t know… Well, they sent me a letter telling me that they were going to discontinue his MediCal because he was in custody. I got a letter from probation letting them know that he’s no longer in custody. So, I gave that to the social worker. So now I’m kind of getting the runaround about who his doctor is, if the Medi-Cal’s any good or onto it’s just a mess. He really hasn’t seen any doctors since he’s been home even though he needs to. – Mother of 19-year-old male
		Difficulty Enrolling in School Post-Release:
	Providers 70.0%	It’s very difficult to get a kid back to a non-public school quickly… There really should be a way …arrangements can be made, so that they don’t have to wait. I mean if a kid misses two days of school, that’s a lot. Beyond that, it’s just criminal. – Judge

Note. Percent Reported includes the percentage of parents (n = 34) and providers (n = 20) who reported the corresponding sub-theme at least once in their interview(s).

Table 5.

Parent perspectives on youth health-detracting responses to adversity.

Health-Detracting Response	Percent Reported (N = 34)	Parent Quote
		Truancy and Defiant Behavior:
Truancy and Noncompliance	10 (29.4%)	He started cutting classes; being very defiant to teachers, to administration, to security. – Grandmother of 16-year-old male
		Continued Substance Use in Reentry:
Substance Use	16 (47.0%)	I still believe he’s in denial that he has an addiction problem… I don’t really believe that he actually mentally realizes that his addiction problem is actually really bad where the point that you can never do it again if you want to live a socialized, normal life. – Mother of 18-year-old male
		Re-Engage with Former Peers:
Risky Social Surroundings	10 (29.4%)	I tell him that he should get friends that he can see are doing something good, not something bad, but like I’m telling you he looks for them—they look for each other because he is here, they call and he leaves or they text, like that. – Mother of 16-year-old male
		Disengage from Treatment/Support:
Poor Treatment Seeking	14 (41.1%)	We had like an orientation meeting with his probation officer, his therapist, his case manager the day after he came home. So they all met with him. And then, they had a couple of meetings with him because he decide ‘I don’t want this. I’m leaving this.’ – Grandmother of 16-year-old male

Note. Percent Reported includes the percentage of parents/caregivers who reported the corresponding sub-theme at least once in their set if interviews.

3. Results

We identified four themes when examining parent and provider perspectives on youth adversity during reentry: 1) youth face challenges tied to reentry; 2) youth return to ongoing challenges in their environment upon reentry; 3) youth engage in health-promoting behavioral responses to adversity; and 4) youth engage in health-detracting behavioral responses to adversity.

3.1. Theme 1: Youth face challenges tied to reentry

Parents and providers expressed that youth experienced high levels of adversity tied to the reentry process, meaning that they felt challenges occurred because of the reentry transition. While parents and providers aligned on the types of adversity experienced by youth, they emphasized different types of challenges resulting from reentry. For example, providers spoke about how attitudes related to mental health affected treatment engagement, while parents highlighted challenges linked to the stigma of incarceration. We categorized the challenges identified by parents and providers that were caused by the reentry process into the following sub-themes: adjustment to home, new responsibilities, and structural barriers to reentry. Sub-themes related to challenges tied to reentry are described below and Table 2 displays representative quotes.

3.1.1. Adjustment to home

Parents reported that youth and their families struggled to re-adjust to each other’s presence during reentry, as well as the lower level of structure in home environments compared to detention facilities. According to parents, youths’ return home often disrupted family social dynamics and triggered conflict in the home. While providers acknowledged the interpersonal challenges of returning home from incarceration, they more often emphasized how the loss of structure previously provided by detention settings might make youth more likely to engage in health-detracting behavior such as substance use. For example, one provider shared, “[Youth] are in camp, in a program that accounts for almost every second of their time and then they come home, and it’s so unstructured, and we expect [youth] to make that transition. I just think it’s unrealistic.” Parents echoed similar thoughts when sharing concerns about youth having idle time post-release.

3.1.2. New responsibilities

Reentry also brought challenges related to new responsibilities faced by youth due to their ongoing court involvement following incarceration. Many parents shared that probation and the courts instructed youth to pursue academic and vocational goals while simultaneously asking youth to comply with stringent requirements. Parents then described youth struggles with balancing new court and probation requirements, such as frequent drug testing and court appointments, with other responsibilities such as resuming school or seeking employment. For example, one parent described her son’s job-related stress and said, “He had a major meltdown… He was supposed to have a job interview on the 16th but things changed with the program. So he was upset… So he did have that meltdown.” While parents and providers acknowledged that court supervision could provide helpful structure to help youth avoid health-detracting behavior, both expressed that youth were sometimes overwhelmed by the resulting pressure and fear of punishment. One provider explained, “When a youth is on probation… it’s like going around with an axe over your head.” Providers also noted how a lack of adequate pre-release preparation and post-release support added to the difficulty of assuming responsibilities during reentry, as youth often lacked the requisite skills and resources to successfully meet the expectations set by probation and the courts. Providers expressed concern that this lack of preparation and support might lead to distress that then drives youth to risky coping behavior.

3.1.3. Structural barriers to reentry

Parents and providers frequently discussed challenges related to the structural barriers tied to reentry, including: access to care, school enrollment, and stigma of justice involvement.

Access to Care.

Several parents shared frustrations related to the discontinuation of youths’ Medicaid, a public health insurance program for low-income individuals in the U.S., during incarceration. Parents and providers explained that the automatic suspension of youths’ Medicaid during incarceration led to issues reactivating insurance at release, which then resulted in difficulties scheduling healthcare appointments and filling medication prescriptions during reentry. In addition, providers highlighted a more general lack of care continuity. Providers explained that youth often respond well to healthcare services received during incarceration but seldom get the same support during reentry. One provider gave the following example, “There are a lot of difficulties getting [youth] back on their medications or they never go back [on their medication] because there isn’t that seamless handoff [at release].” Thus, parents and providers expressed repeated concerns related to healthcare access, typically connected to discontinued health insurance and poor continuity of care between detention and community health settings.

School Enrollment.

Structural barriers to reentry disrupted continuity in education as well, with multiple parents and providers describing difficulties related to school enrollment. One parent shared, “School is giving us a really hard time to take [youth name] back. It took approximately three months to get him back and he wasn’t fully enrolled yet because they’re saying that [papers] are not in order from the court.” Similarly, one provider expressed, “One of the biggest gaps was with school enrollment, and so kids would come back from camp and three or four weeks later, they’re still not in school, which to me was unforgiveable.” Parents and providers worried that a lack of structure and too much idle time resulting from gaps in school enrollment might make youth more susceptible to engaging in health-detracting behavior.

Stigma of Justice Involvement.

Parents and providers also discussed stigma towards youth with histories of incarceration as a structural barrier tied to reentry. For example, one mother expressed frustrations about job discrimination related to her son’s incarceration history when saying, “It’s so hard for [youth] to get their life back together, to find a job because of their convictions.” Similarly, another mother shared:

Those [youth] that have the opportunity that leave [detention] and can work, they don’t get accepted, why? Because of their record… That is another reason [youth are] going back to doing the same things because they try do things the right way and [employers] won’t let them because of their record.

In addition to the impact of stigma on job opportunities, providers described how stigma and implicit biases might harm justice-involved youth as educators and other health and service providers might give youth with recent justice involvement less attention or care as a result of lowered expectations or negative stereotypes. For example, one provider shared:

I think just in general one of the barriers that our students face is that, unfortunately, a lot of adults don’t give [justice-involved youth] a chance… There is just a general sense, you know, that [justice-involved youth] might be judged… and sometimes adults don’t give [justice-involved youth] a second chance.

Though parents discussed stigma and discrimination related to employment opportunity and also reported frustrations with healthcare and education, they did not explicitly discuss discrimination related to school settings and service provision.

3.2. Theme 2: Youth return to ongoing challenges in their environment upon reentry

In addition to reentry-specific challenges, parents and providers explained that youth undergoing reentry return to ongoing challenges in their home, neighborhood, and community environments that typically predate justice involvement. Most discussion from parents and providers on youth adversity in reentry centered on challenges that were generally independent of reentry, and, in some cases, may have contributed to initial justice involvement. The ongoing challenges encountered by youth during reentry identified by parents and providers subdivided into the following sub-themes: negative neighborhood influence, family challenges, and ongoing structural barriers (Table 3).

Table 3.

Parent and provider perspectives on ongoing adversity during reentry.

Ongoing Challenges	Percent Reported	Parent and Provider Quotes
		Peer Influence to Engage in Criminal Behaviors:
Negative Neighborhood Influence	Parents 26.4%	As soon as [youth’s peers] feel that [youth name] is back, they come looking for him. – Mother of 18-year-old male
		Proximity to Drugs and Violence:
	Providers 35.0%	So, we have the violence is in the community, drugs in the community. Both impact [youth] together… And especially those [in] the population that has a somewhat a little bit of a mental illness or the emotional issue involved. Because they are more vulnerable to those kind of scenarios, so they tend to get into sort of fall back, basically. – Correctional Mental Health Provider
		Family Mental Health Challenges:
Family Challenges	Parents 17.6%	No. My Husband had a mental breakdown and he kind of did some things and a lot of judgement and resentment is there and [youth name] just has on forgiveness now.” – Mother of 19-year-old male
		Low Parent Engagement:
	Providers 25.0%	You’ve got to get signatures from the parents… The biggest obstacle is probably just the parents; meeting up with them and having them buy into [treatment]. – Community Mental Health Provider
		Underfunded Vocational Programs:
Ongoing Structural Barriers	Parents 32.3%	He got a couple of hiccups and everything where they were supposed to help him get a job and he filled out the paper work and everything, but the place, they haven’t got their funding, so he has, you know no job, so you know when, when you don’t have anything to do you just do something else… He was doing really good and now he’s kind of not. – Mother of 18-year-old male
		Geographic and Transportation Barriers:
	Providers 75.0%	I think some of the issues are if we offer services, opportunities to go someplace some of it depends on distance from [youths’] home or transportation for them to go from their home to the clinic and back – Correctional Health Provider

Note. Percent Reported includes the percentage of parents (n = 34) and providers (n = 20) who reported the corresponding sub-theme at least once in their interview(s).

3.2.1. Negative neighborhood influence

Parents and providers identified negative influences in the neighborhood or surrounding community as a major source of ongoing difficulty for youth undergoing reentry. In particular, parents and providers emphasized the presence of drugs and alcohol in the neighborhood, which they feared would result in youth substance use and recidivism. In contrast, providers more often spoke of youth as victims of violence and described physical injuries. For example, one provider shared, “[Youth] have a fair amount of injuries… certainly gunshot wounds and retained bullets can be a problem.” While parents did not explicitly discuss the potential for their youth to fall victim to violence, they did describe their neighborhoods as generally unsafe, going so far as to express desires to move, often in response to nearby gang activity and other crime.

3.2.2. Family challenges

Parents and providers explained that returning home also meant returning to family challenges for youth. Parents most often described family challenges in youths’ household environment. For example, one mother shared concerns about financial stressors and how her unemployment and loss of income might have pushed her son towards criminal behavior as a way to meet his basic needs. This mother explained, “Yes, the money and, well, that’s what mortifies me… I am worried because I think that’s why [youth name] used to leave the house because before I didn’t have a job.” Returning home also meant youth resumed familial responsibilities, which parents viewed as challenging for youth. One mother described her son’s struggles to balance his role as a father with his new responsibilities tied to reentry (e.g., court appearances). She stated, “He still needs some work in some area as far as transitioning on how to hold down to go to school and be a father.” Parents demonstrated deep compassion and insight into the multiple family challenges experienced by youth during reentry.

In contrast, when discussing challenges that arose during reentry related to families, providers focused on challenges with low family engagement in limiting youths’ participation in behavioral health treatment and case management services. For example, one provider shared:

The biggest obstacle is probably just the parents; meeting up with them again and having them buy into it. But the one I notice—that’s usually for the initial ones. If somebody has wraparound and then they went to camp and they come back out, their parents usually are pretty much buying into it a little easier because their experience with them has always been positive.

Still, despite the focus on family engagement in influencing youth treatment participation and buy-in with recommended care, providers occasionally acknowledged other potential family challenges such as household conflict or childhood adversity.

3.2.3. Ongoing structural barriers

In addition to structural barriers tied to reentry, parents and providers also described ongoing structural barriers limiting youths’ health and success that existed independent of the reentry process. Parents and providers often discussed issues related to healthcare access, describing barriers such inaccessible healthcare locations, appointment unavailability, and a lack of resources to pay for healthcare services (including due to insurance co-pays). Spanish-speaking parents reported unique challenges related to ongoing structural barriers across several domains, including healthcare access, education, and interactions with the justice system. For example, one mono-lingual Spanish-speaking parent described language barriers, saying, “No, they gave me everything in English… I went all the way over there and they all spoke English.” Another parent described ongoing structural barriers related to immigration status: “[Youth name] needs a social security number and well he doesn’t have one. He can’t get a job… He [asked] ‘how can I get [a job]’ and I tell him well you can’t because you weren’t born here.” Generally, providers described similar ongoing structural barriers as parents. Additionally, providers described that negative views towards behavioral healthcare could prevent some youth from connecting with needed care. As one provider explained, “There’s not much of a tendency to focus on mental health because there’s stigma.” Another provider described how cultural narratives and experiences might adversely affect non-White youth by discouraging them to seek care: “Well, culturally, almost all cultures… and I’m being facetious—except rich White people in Beverly Hills—avoid mental health services, particularly teenagers, because they don’t [think] they have a problem or it’s something they should handle themselves.” Thus, parents and providers agreed that structural challenges to youths’ health and wellbeing exist independent of reentry but emphasized different barriers.

3.3. Theme 3: Youth engage in health-promoting behavioral responses to adversity

In addition to describing the adversity experienced by youth undergoing reentry, parents and providers discussed how youth responded to adversity during reentry as it related to health. Compared to providers, parents more readily discussed youth responses to adversity during reentry, especially when sharing youths’ health-promoting responses to adversity during reentry. As such, provider perspectives did not include all of the health-related behaviors shared by parents. The health-promoting behavioral responses to adversity grouped into the following subthemes: pursuing education and employment, abstinence from substance use, healthy social surroundings, and help seeking (Table 4).

Table 4.

Parent perspectives on youth health-promoting responses to adversity.

Health-Promoting Response	Percent Reported (N = 34)	Parent Quote
		Structure Provided by Education and Employment:
Pursuing Education and Employment	26 (76.4%)	He’s doing excellent. He’s going to school; he has a job, goes to work and goes to school. Comes home, cleans up the house, you know? He has a program… He should be graduating within the next couple of weeks. – Mother of 17-year-old male
		Initiating or Maintaining Abstinence from Substance Use in Reentry:
Abstinence From Substance Use	13 (23.2%)	I think it’s because he was doing illicit drugs and stuff, but he’s not doing anything now. – Mother of 18-year-old male
		Connecting with New Peers:
Healthy Social Surroundings	17 (50.0%)	Actually, a group of young men that he was involve with, they promote nothing but positiveness. They were there for him whenever he felt pressure or needed help with anything. They really made themselves available to him so I think that was quite a big help to him. – Mother of 19-year-old male
		Strong Engagement with Healthcare:
Help Seeking	24 (70.5%)	I think he was seeing a psychiatrist… He is like outgoing. You know, he doesn’t hold back. And he’ll tell them, how he feels and stuff. He won’t hold his feelings back even if it’s a sensitive issue or whatever. – Mother of 18-year-old male

Note. Percent Reported includes the percentage of parents/caregivers who reported the corresponding sub-theme at least once in their set of interviews.

3.3.1. Pursuing education and employment

A common health-promoting behavior highlighted by parents was youth pursuing educational and vocational goals, which they felt encouraged youths’ overall wellbeing and likelihood of reentry success. Parents and providers viewed youth efforts towards educational and vocational goals as central for facilitating successful reentry. Though parents acknowledged the potential stress of assuming additional responsibilities in school or work, they also felt that those same responsibilities provided structure and accountability that helped youth avoid health-detracting behavior. For example, one parent shared, “He’s focusing on his life and so he’s more into his career right now and bettering himself as far as the future.” Providers similarly discussed the importance of school and work in providing structure and support during reentry. Parents mostly attributed youth motivation to pursue educational and vocational goals to legal supervision and court mandates, as judges and probation staff often instructed youth to complete school and seek employment. Thus, even with the additional stress, parents and providers viewed educational and vocational pursuits as overall health-promoting.

3.3.2. Abstinence from substance use

Parents reported that youth initiated or maintained abstinence from substance use during reentry as a key health-promoting behavior, often in response to court mandates and legal supervision. Though parents perceived substance use as health-detracting, they more frequently cited legal worries over direct negative health effects. Parents often shared worries related to youth failing mandatory drug tests and incurring further legal sanctions, if youth engaged in substance use during reentry. Of note, parents regularly framed abstinence as a pivotal change in facilitating health-promoting behavior and successful reentry, often while hinting at youths’ previous struggles to abstain from substance use prior to incarceration. For example, one father expressed welcomed surprise when stating, “That’s funny to say nowadays, but no, he doesn’t. He don’t smoke. He don’t drink. He’s alright.” Providers also spoke to substance use as a common challenge that needed to be prioritized among youth undergoing reentry, but they typically did not elaborate on the topic outside of discussing its high prevalence in juvenile justice populations.

3.3.3. Healthy social surroundings

Parents occasionally described intentional efforts by their children to alter social surroundings as a strategy to avoid temptations from negative neighborhood influence and to prevent recidivism. Parents reported that youth avoided former peers, sought new friendships, and worked to mend or strengthen family relationships. For example, one mother shared, “The only time [youth’s name] does leave [home] is when he needs to look for a job… Normally, he doesn’t go out and associate with anybody out of the home.” Though most discussions from parents focused on peer avoidance, parents also reported powerful positive changes whenever youth formed new peer connections, sharing vague language about youths’ general improvements in mood and motivation to succeed in response to making new friends.

Parents also reported improved family relationships as a result of youth changing their social surroundings, as parents perceived youths’ altered social behaviors as youth following parental guidance. Moreover, parents reported youth efforts to strengthen or mend family relationships during reentry, typically through youth assisting with household chores or youth displaying willful adherence to household rules.

Parents did not specify what aspects of incarceration or reentry produced youths’ behavioral change in the household. Instead, parents reported observing changes in youth attitudes and described their children as more mature, appreciative, or motivated to succeed, after incarceration. While providers agreed with parents on the importance of peer or social influences in shaping behavior, they focused mainly on the dangers of negative influences during reentry and rarely described health-promoting behaviors in social contexts.

3.3.4. Help seeking

Parents and providers commonly reported youth engagement with needed medical and behavioral health treatment and additional reentry services as promoting health and reentry success. Compared to providers, parents commented more frequently on youths’ independence towards help seeking during reentry. Common examples included youth scheduling their own healthcare appointments or consistently engaging with case management services. For example, one mother explained that her son attends therapy mostly without her involvement, “[Youth name] does get one-on-one therapy here at the home… I haven’t really had a chance to be part of it… Normally they come in the daytime when I’m at work.” Parents described benefits to youth from youth successfully seeking and receiving treatment during reentry. As one mother shared, “[Youth name] has been in therapy with different agencies… [We] thought she wasn’t listening [but] somewhere down the line, she heard a lot of things from a lot of people, and for that, I’m forever grateful.” Similar to other youth health-promoting behaviors during reentry, parents most frequently attributed youth help seeking to parental guidance or instruction from court and probation. In addition, parents stated that previous positive experiences with treatment and feelings of progress reinforced and motivated continued help seeking and treatment engagement. Similarly to parents, providers highlighted the potential value of court supervision in promoting help seeking. As one provider stated, “Is the kid on ankle monitoring? Sometimes that makes it a little bit easier to keep appointments with the [wraparound] team.” Further, providers emphasized the importance of treating youth with compassion and understanding in order to facilitate high engagement and improved health outcomes.

3.4. Theme 4: Youth engage in health-detracting behavioral responses to adversity

Parents and providers reported that youth engaged in health-detracting behaviors in response to adversity experienced during reentry. Compared to health-promoting responses, providers more readily described youth health-detracting behaviors during reentry. As expressed by parents and providers, youth health-detracting responses to adversity during reentry included: truancy and noncompliance, substance use, risky social surroundings, and poor treatment seeking (Table 5).

3.4.1. Truancy and noncompliance

Parents and providers expressed that some youth did not fulfill responsibilities at school, work, or probation, leading to setbacks and distress during the reentry period. Most discussions of youth noncompliance focused on probation violations, such as breaking house arrest orders or substance use. However, parents and providers also described truancy and disruptive classroom behavior. For example, one parent shared, “[Youth name] is having a heck of a time being able to function in the classroom because [he] is arguing with the teacher, and then he would get sent to the office and he would argue there.” When describing challenges related to youth truancy or noncompliance, providers made sure to emphasize how environmental and contextual factors often drove youth behaviors during reentry and called for an increased focus in addressing system-level barriers.

3.4.2. Substance use

Parents expressed worries about youth substance use in response to adversity during reentry mainly because it could cause youth to incur further legal consequences, in addition to having adverse health impacts. While some parents acknowledged youth progress in reducing or altering substance use to less risky substances during reentry, parents valued abstinence far above reduced use because parents prioritized the avoidance of legal consequences linked to mandatory drug tests. Nearly half of parents and more than one-third of providers spoke to youth struggles to avoid or reduce substance use during reentry. One provider described the prevalence of substance use among justice-involved youth when saying, “Another issue for [youth] who are incarcerated is the use of alcohol and [other] drugs, which probably hits 90% of [youth].” While parents and providers agreed on the prevalence and difficulties of substance use, they differed on the factors motivating youth substance use. Parents more commonly described youth substance use as triggered by home and neighborhood contexts, whereas providers pointed to unmet behavioral healthcare needs. Specifically, providers more commonly described youth substance use as a coping response to distress, while parents attributed substance use to peer pressure or other forms temptation.

3.4.3. Risky social surroundings

Both parents and providers discussed risky social surroundings as a challenge during reentry related to negative peer influence and temptation to engage in risky behavior, mainly substance use. Parents spoke at length about the health-detracting impacts of youth associating with peers whom parents identified as negative influences. Parents feared that risky social surroundings might lead to temptation, pressure, or opportunity to engage in substance use and other risky behavior, which they said could lead to recidivism and poor health outcomes, even death. As one parent explained, “He’s fallen in the wrong crowd. He thinks fast life and fast money is the way to go. And I keep telling him, look at all your friends that have died. Fast money and fast life.” Parents further explained that youths’ continued association with peers who parents perceived to be negative influences strained family relationships, as parents felt youth defied their guidance. Many parents encouraged youth to avoid negative peers. While parents typically viewed peer avoidance as overall health-promoting, some reported that peer avoidance sometimes resulted in youth feeling lonely or isolated. Parents shared that youth sometimes avoided social interaction altogether in a well-meaning effort to avoid unwanted influence. Thus, parents related that some youth unintentionally distanced themselves from family and other social supports in their attempts to avoid negative influence. Providers agreed with parents on the dangers of risky social surroundings but more frequently emphasized aggressive, criminal, or gang-related behaviors.

3.4.4. Poor treatment seeking

Parents and providers reported that youth often demonstrated poor treatment seeking and, as a result, youth did not receive sufficient support to address various challenges related to their health and new responsibilities. Common examples included missed healthcare appointments, abruptly discontinued treatment, and reluctance to seek care. Reports of poor treatment seeking often overlapped with discussions of substance use. Parents expressed frustrations as they felt youth minimized or denied substance use struggles. For example, one parent shared, “[Youth name] struggles with substance [use] as far as marijuana, yes. He does have a problem that he don’t admit to… I believe he has a problem. He denies that he even uses it, but I know he does.” Further, parents and providers reported that youth sometimes viewed substance use as health-promoting, yet parents and providers maintained that substance use was health-detracting. For example, one mother explained her daughter would likely refuse beneficial substance use treatment services: “[Youth name] sees nothing wrong with [substance use]. She sees the fun in it. She sees the laughter. She doesn’t see anything wrong with it.” Thus, much of parents’ concerns related to poor treatment seeking related to youths’ attitudes towards care.

Even when youth did connect with medical or behavioral healthcare services, some parents described youth as disengaged from treatment, reporting behaviors such as sporadic attendance to healthcare appointments and poor adherence to provider recommendations. As such, parents and providers expressed concern that untreated or unmanaged symptoms might impede successful reentry, even when youth were connected to various supports. Parents and providers also described how unaddressed healthcare needs might lead to other health-detracting behaviors, especially substance use. Many providers expressed that youth substance use stemmed from unaddressed behavioral health needs.

4. Discussion

Overall, parent and provider perspectives support that youth undergoing reentry experience substantial adversity that influences their immediate and long-term health. Parents and providers agreed that youth simultaneously contend with reentry-specific barriers and ongoing challenges independent of the reentry process that are both exacerbated by structural barriers limiting access to needed support (Freudenberg et al., 2005). According to parent and provider interviews, reentry adversity operated across social-ecological levels, including various microsystems, mesosystems (i.e., relationships between microsystems), and the macrosystem (Bronfenbrenner, 1979). Although some of the reported challenges remained specific to certain microsystems (e. g., home, school, or work), other barriers cut across microsystems (i.e., to affect mesosystems between home, school, or work). Further, barriers in and between microsystems all operated under a macrosystem with significant barriers and stigma towards justice-involved families, all of whom in our sample identified as Black or Latinx, which is common in justice-involved populations (Owen & Wallace, 2020; Sickmund et al., 2019).

4.1. Microsystem and mesosystem challenges and opportunities

Parents and providers reported challenges specific to different microsystems such as temptation and negative influences in youths’ neighborhoods and communities. However, parent and provider discussions on structural barriers focused more on links between microsystems (i.e., youths’ mesosystem), typically connected to poor continuity of care and inadequate access to support during reentry. Given parent and provider concerns related to continuity of care, findings suggest that steps can be taken to improve continuity of care for youth undergoing reentry. Parents most often reported difficulties with public health insurance activation and school enrollment; thus, facilitating smooth transitions in the form of automatic insurance reactivation and improved collaboration between education and carceral systems can ease the burden of reentry (Albertson et al., 2020). Moreover, a stronger emphasis on linking youth to resources and services before release can help close gaps in care (Mathur & Clark, 2014). Finally, parents and providers shared optimism about the potential positive impacts of providing adequate care and expressed belief in youths’ resilience to manage the challenges of reentry if given proper support. Taken together, parent and provider perspectives indicate a need to buttress and expand systems of reentry support to ensure adequate access to healthcare and other services.

4.2. Macrosystem challenges and opportunities

Parents and providers specifically described challenges related to the larger cultural context or macrosystem (Bronfenbrenner, 1979) of systemic racism, albeit more often indirectly. For example, both parents and providers spoke to discrimination. Parents shared discrimination as a result of youths’ justice involvement, as well as a lack of resources or opportunities for justice-involved youth. Similarly, providers expressed concerns regarding implicit bias among educators and providers against justice-involved youth. Further, with the disproportionate representation and differential treatment of Black and Latinx youth in the U.S. criminal justice system (Rovner, 2016; Starr & Rehavi, 2013; Sickmund et al., 2019), it is difficult to separate attitudes of justice-involvement from racism, classism, and other marginalization. Parents’ concerns related to limited opportunity show a need to create and improve educational and vocational opportunities for justice-involved youth and marginalized communities. Provider reports of harmful beliefs and stereotypes show how macrosystem level barriers can negatively impact justice-involved youth across varying environments and contexts. Further, prior research has shown that supportive relationships can protect youth from other harmful interactions within their various microsystems (Johns, 2018; Johns et al., 2017). Thus, it is vital that adult health and service providers respect and are activated to support justice-involved youth. Overall, parent and provider perspectives show an urgent need to implement anti-racist policies, trainings, and education to support justice-involved youth during reentry.

Providers also spoke to others challenges in the macrosystem related to negative attitudes towards behavioral healthcare, an issue of particular importance given the high prevalence of psychiatric disorders in the U.S. juvenile justice population (Owen & Wallace, 2020; Teplin et al., 2002). Providers most often discussed how parent attitudes might affect youth engagement with behavioral health treatment, while parents focused more on barriers to healthcare access. Notably, all parents in our sample were Black or Latinx; thus, structural issues related to racism are particularly relevant to the health of their youth (Duarte et al., 2020; Laub, 2014). Taken together, parent and provider interviews speak to a need to address larger structural challenges related to behavioral healthcare, including advocacy to improve attitudes on behavioral health and policy changes to dismantle logistical barriers to healthcare access and reentry support.

4.3. Leveraging motivations for health-related behaviors during reentry

Regarding youth responses to adversity, parent and provider interviews expressed that youth health-related behaviors coincided with specific types of adversity. For example, parents and providers reported substance use as one of the most common health-detracting behaviors among youth, while also frequently sharing concerns related to neighborhood influences on drug use. Moreover, several parents described youth efforts to deliberately avoid peers in order to reduce or avoid substance use. Reported concerns on youth substance use align with the documented high rate of substance use disorder in the juvenile justice population (Teplin et al., 2002) and previous work linking exposure to neighborhood violence and substance use to recidivism (Fehon et al., 2001; Phillips & Lindsay, 2011). Parent and provider concerns about environmental and contextual factors indicate a need to further consider an ecological-systems based approach to understand and support youth undergoing reentry. Future work might aim to consider system-level challenges for youth undergoing reentry rather than focusing solely on the individual youth.

Parent and provider perspectives also indicate that specific motivations more reliably led youth to either health-promoting or health-detracting behavior. For example, parents explained that court mandates and legal supervision exclusively motivated health-promoting responses, but also caused youth distress. Thus, parent reports suggest the benefit of courts and probation—or other child-serving agencies—to support and encourage health-promoting behavior with a structured, but non-punitive approach. Parent perspectives align with previous work suggesting that strict probation demands have been shown to be overwhelming and ineffective in reducing recidivism (Mendel, 2018), whereas a supportive and developmentally-informed approach may be more effective in reducing “offending” (Henderson-Frakes et al., 2017; Johns, 2018; Johns et al., 2017). Courts working with youth populations can reexamine their approach to legal accountability to more effectively leverage youths’ natural motivations to promote health. Moreover, a prioritization of diversion and other alternatives to incarceration can help youth and their families avoid the challenges of justice involvement and reentry altogether (Wilson & Hoge, 2013), while also rectifying racial disparities in juvenile justice related to the differential treatment of Black and Latinx youth (Kakade et al., 2012; Puzzanchera et al., 2016; Starr & Rehavi, 2013).

In contrast to court and probation motivators, parents and providers described a mixed response to peer influence, as “old” peers were generally viewed as health-detracting, while “new” peers were typically seen as health-promoting. However, parents often reported healthy behavioral change in response to youth connecting with new peers, suggesting healthy peer interactions as a potentially underutilized form of support (Hunter et al., 2017). Finally, parents often reported their own guidance as motivating youths’ health-promoting behavior, aligning with previous work showing that parents play an important role in motivating youth to connect with needed support during reentry (Barnert, Lopez, Pettway, et al., 2020). However, parents also described important differences in how they viewed their child’s needs and challenges, particularly related to substance use and behavioral healthcare. As previous research has shown that parents perspectives differ from youth (Trout et al., 2014), future work might focus on helping families reconcile differences in youth and parent perspectives related to reentry challenges and healthcare needs. Together, these finding suggest the potential to improve youth interventions by centering them on youths’ natural motivations and better integrating social supports across and within various microsystems, especially parents, to more effectively promote the health of youth undergoing reentry.

5. Limitations

Our study approach raises some limitations. First, participants may have avoided sensitive or stigmatized topics, such as trauma or racism (Goffman, 1963; Grimm, 2010), which were not specifically probed in the interviews. While interviewers aimed to match participants by race/ ethnicity, it was not always possible. Even when matched, other factors such as age or perceived socioeconomic status may have limited rapport. Lack of trust may have also caused parents to avoid reports of youth criminal behavior over concerns of legal consequences. Future studies might directly query sensitive topics such as a race or trauma to better understand the perspectives of families affected by the juvenile justice system. Second, our secondary data analysis approach limits comparisons between parent and provider views, as discrepancies between the two perspectives might stem from differences in interview intent; whereas parents were asked about the specific needs and experiences of their children, providers discussed barriers experienced by the justice-involved youth population in Los Angeles County. Future work can aim to more directly compare perspectives, while also integrating a more nuanced view of health behaviors to include responses such as harm reduction. Finally, while parents provided valuable insight on youth experiences, all parents were identified by their children as Black or Latinx, so their experiences might not generalize to other racial/ ethnic groups or to families outside of Los Angeles County. Future research might integrate and compare more diverse and varied perspectives in order to obtain a more comprehensive view of the challenges surrounding community reentry after incarceration. By addressing key limitations and building on current findings, future research and work can help youth more successfully navigate the critical yet vulnerable period of reentry so that youth can flourish post-incarceration.

5.1. Conclusion

Parent and provider perspectives indicate that youth face adversity within and across various systems and contexts, both in the form of ongoing challenges and reentry-specific barriers. Parents and providers reported that youth engage in coping strategies that both promote and detract from health. At the same time, parents and providers shared that youth responses can be driven by specific challenges and motivators, suggesting the potential to shape youth behavior in ways that promote health and wellbeing during reentry. With repeated concerns related to environments and contexts, future work and intervention might utilize an ecological-systems based approach to address adversity at all levels, ranging from the high healthcare needs of justice-involved youth to the structural barriers linked to health disparities and racial inequity. In addition to systemic changes at a macro-level, future intervention should aim to include youths’ most natural allies, their parents, in collaboration with health and service providers in order to leverage their insight and expertise to improve reentry outcomes. Through meaningful partnership, intentional research, and a continued focused on equity, future work can help tip the balance in favor of justice-involved youth to promote their health and wellbeing, disrupt patterns of repeat incarceration, and break cycles of escalating adversity.

Appendix A. Supplementary material

Supplementary data to this article can be found online at https://doi.org/10.1016/j.childyouth.2021.106007.