Designing Technology-Assisted Interventions for Justice-Impacted Black American Women

Abstract

This study explores the challenges faced by justice-impacted Black women during their reintegration into society, with a focus on mental health care access and the potential for technology-assisted interventions to address barriers. Participants from focus groups emphasized significant obstacles, including inadequate mental health resources during incarceration, insufficient post-release support, and barriers such as discrimination, lack of insurance, and transportation issues. When designing technology-assisted interventions, such as the Welcome Home app, additional considerations for justice-impacted Black women include trauma-informed design, tiered support systems, integration with electronic health records, privacy protection, and culturally tailored content. The study underscores the importance of culturally relevant, user-centered digital solutions to improve health outcomes and facilitate the successful reintegration of Black women impacted by the criminal legal system. Apps that provide a sense of community promote engagement, which may improve health outcomes.

Introduction

Digital technologies have become deeply embedded in daily life, shaping how we communicate, access services, and interact with the world. However, for many marginalized communities—particularly Black American women, with incarceration rates 1.7 times higher than their White counterparts¹—these technologies can present significant barriers. Rather than acting as empowering tools, digital technologies often become “reimagined” sites of oppression and surveillance, failing to meet the unique needs of the people they intend to support². These technologies frequently perpetuate carceral logic(s) within seemingly benevolent institutions, reinforcing systems of control, exclusion, and stigmatization³. As a result, marginalized communities are disproportionately impacted, further entrenching cycles of punishment and oversight⁴. Instead of facilitating reintegration, these digitized systems can further limit access to essential resources, undermine autonomy, and complicate the process of rebuilding a life post-incarceration.

Among the most pressing issues faced by formerly incarcerated individuals is the lack of access to mental health care. Research consistently shows that mental health treatment is crucial for successful reintegration, with significant implications for both physical health and recidivism rates^5,6. However, formerly incarcerated women face multiple barriers to accessing mental health services. These include a lack of insurance, limited healthcare resources, financial constraints, and difficulties with transportation^7,8. For Black women, these challenges of access to services are often further exacerbated by racial and gender discrimination, pushing many to rely on informal networks such as family, friends, and religious institutions for support^9,10. While these informal networks can offer valuable support, they are often inadequate on their own in addressing the complex mental health needs crucial for successful reintegration.

Considering these challenges, researchers have turned to personalized health libraries—digital platforms designed to provide tailored health information to individuals reentering society after incarceration¹¹. These tools aim to empower formerly incarcerated individuals by offering access to relevant health resources, supporting wellness, and helping navigate the healthcare system¹¹. However, Black women, who are disproportionately affected by the criminal legal system, face unique challenges stemming from intersecting forms of discrimination tied to both their race and gender¹². Consequently, this should be considered when designing digital technologies to support them, as gendered anti-Blackness embedded in both digital technologies and institutional structures often excludes them from the assumptions about ‘typical’ technology users. This paper explores how technology-assisted interventions, primarily mobile applications (apps), can be designed and adapted to more effectively meet the needs of Black women impacted by carceral institutions. By examining the intersectional identities of race, gender, and criminal justice involvement, we aim to provide insights into how these digital tools can better support this underserved population.

Methods

We recruited community members age 18 years or older who self-identified as a Black or African American woman, had a history of incarceration, and English-speaking. Recruitment methods included receiving an invitation to participate in the study via word-of-mouth (eg, community health worker) or flyer posted in community settings (eg, outpatient clinic, community re-integration center). Each participant received a gift card (50 USD value) for completion of the study. The study was conducted in 2022-2023 through four focus group sessions, with prior research revealing that more than 80% of all themes are discoverable within two to three focus groups, and 90% of themes could be discovered within three to six focus groups¹³. Each focus group session was capped at no more than five participants to create an environment where all participants could fully engage in the discussions. The sessions were held in private meeting rooms, in a location that was familiar and accessible to participants. TM moderated the discussions and noted language used, non-verbal cues, and emerging themes. Focus group participants signed a written consent form prior to participation. Participants were advised that the session would last 1 hour to 1 hour 15 minutes and that anything shared in the room should be kept confidential and not discussed outside of the session.

The interview guide contained questions about attitudes toward mental illness and receiving mental health treatment; barriers and facilitators to accessing mental health care; coping skills/strategies used in the past; informal sources of support; past use of personal health information technology; content and features that should be included in an app to support the mental health of formerly incarcerated Black women (e.g., preferred resources); and concerns about using the app (Appendix A). Each focus group session was audio recorded and transcribed for analysis. Rapid qualitative analysis methods were used to determine themes and insights for design and development of the app. Each member conducted rapid analysis of the focus group transcripts, and the team met regularly to discuss emerging themes (TM, AL, MSw, BM). The insights for design were used to inform the development of a mobile app to support individuals with a history of incarceration as they rejoin their communities, the Welcome Home app. The flow chart of the user-centered design process is outlined in Figure 1 and presented in the published design paper for the Welcome Home app11. Detailed methods for the full study are outlined in the published protocol paper¹⁴. The study was approved by the Yale University Human Subjects Research Committee Institutional Review Board (IRB #200028862).

Figure 1.

Flow chart of user-centered design process.

Results

Fourteen participants attended one of four focus group sessions (3-5 participants per focus group). Each session lasted approximately 1 hour to 1 hour and 15 minutes. Study participants ranged in age from 23 to 54 years, and all identified as female and either Black or African American. All participants had a history of incarceration and resided in New Haven, Connecticut (USA) or surrounding areas. The participants discussed their opinions on what “good” (eg, peace) vs “bad” (eg, mental breakdown) mental health looks like, and past experiences and trauma they felt impacted their mental health. In general, when participants were diagnosed with a mental health condition, they did not feel like they understood their mental health diagnoses, benefits and side effects of medications, and alternative treatments. Pseudonyms were used to protect the identity of the participants.

“I want to know how you came to your conclusion, break it down to me. So I understand how you understand.” [Maya, 24 years old]

“And let’s agree on something, instead of you just trying to force something onto me that I might not like.” [Lynn, 26 years old]

“Explain this pill to me, and all the side effects. Not just it’s going to calm you down.” [Toni, 38 years old]

Participants voiced they had mostly negative experiences using mental health services and resources while incarcerated, such as group therapy and the “medline” (ie, line they stand in to receive medications).

Upon release from incarceration, participants were given a packet of information which was viewed as inadequate to support their transition to the community. “You do your time, and they throw you out. You have to want it and seek it for yourself, because when you leave the prison, they don’t tell you nothing. They just release you and go about your merry a** way. Pack your stuff, you’re leaving. Bye. And later kind of thing. That’s what they do. They don’t help you with nothing at all.” [Joan, 53 years old]

In general, participants felt an app that provided content and features to address basic needs - employment, housing, and health care needs would be helpful during the reentry period. Further discussion about designing technology- assisted interventions for justice-impacted Black American women revealed the following top 10 considerations (Figure 2): (1) trauma-informed design (eg, safety principle – consistency and explanations; trust – provide up-to-date and relevant information); (2) support needs to be presented in a tiered format, escalating from support for self-management, to peer support (eg, support groups for women), to community health worker support, to crisis support (eg, domestic violence shelter); (3) interoperability with the user’s Electronic Health Record (EHR) patient portal (eg, MyChart); (4) connection to a 24-hour crisis line; (5) link to podcasts that focus on Black women’s mental wellness (eg, Homecoming by Dr. Thema Bryant™ and Therapy for Black Girls by Dr. Joy Harden®); (6) information to join in-person support groups (eg, Women Healing Hearts – group to support formerly incarcerated women led by MS); (7) personalized content and activity recommendations based on age group; (8) support (including mental health support) for reconnecting with family, specifically children, once released; (9) resources for obtaining rides at night for safety; and (10) ensure HIPAA compliance, and disable screenshotting to protect the privacy of user.

Figure 2.

Recommendations for designing technology-assisted interventions for justice-impacted Black women.

Participants expressed openness to using the app if it was reliable, easy to navigate, accessible, and provided accurate, location-specific information about resources. The participants’ concerns were primarily about privacy, such as preventing support staff from taking screenshots of private conversations and uncertainty about what would happen if the application malfunctioned. The recommendations were incorporated into the design of the Welcome Home app. Future work includes formal usability testing with intended users. The findings will be used to inform further refinement of the app prior to a randomized pilot trial.

Discussion

Black women who are justice-impacted have many barriers to reestablishing themselves during the transitionary period from carceral facilities back to communities. Support is often limited and highly dependent on their networks. Information on how to obtain basic needs such as housing, employment, and health care can be difficult to access. There is also a need for legal and social support (including mental health resources).

Overall, justice-impacted women have difficulty accessing mental health care⁶. Barriers to receiving mental health treatment after release include, lack of health insurance, cost of medication, less access to services and support (unless it is an emergency or related to substance use treatment), lack of transportation, and lack of knowledge regarding mental illness and treatment options^7,8. Black women face significant challenges to receiving mental health care which are worsened by facing discrimination while navigate a cumbersome healthcare system as a double minority (Black and female)¹⁰. Technology assisted interventions for this group should directly provide culturally appropriate mental health support or connection to support.

Focus group participants expressed shared thoughts, recommendations, and opinions that reflect their individual experiences; however, these findings should not be generalized to all Black women with a history of incarceration. Limitations include that we could not assess socioeconomic status because income data was not collected. Furthermore, the geographical limitation in participant recruitment means the results may not represent the views of a nationally diverse sample.

Conclusion

Mental health care within the carceral system is over-medicalized, and the support provided during the reentry period is often insufficient. Apps that are designed to support Black women during the reentry period should be trauma-informed, facilitate connections to resources, and provide a sense of community.

Appendix A

Focus Group Interview Guide for Black Women with History of Incarceration

1. When you think about “bad mental health,” what goes through your mind?

2. When you think about “good mental health,” what goes through your mind?

3. Thinking about when you were told you have a mental health condition, did you feel you understood what it meant?

   1. Did you understand the symptoms, options for treatment, and side effects of medications that were prescribed?
   2. What information would you like to have known? Example, if needed: treatments, side effects, holistic approaches.

4. We will get to it in a minute, but outside of using mental health services or medication, what are some of the ways you tried to take care of your mental health while incarcerated? Example, if needed: meditation, hobbies, scheduled calls with family/friends.

5. What mental health services and resources did you use while you were incarcerated?

   1. Did you feel that they were helpful? Can you tell me more about that?
6. On your release from corrections settings, what mental health services and resources did you need to be able to access?

   1. Was there any information given to you or support provided that helped you access mental health services or medications during that time? What were they?
   2. Were there any challenges to accessing services or medications? What were they?
   3. What type of information or support do you feel would have been helpful to have to make it easier to access mental health services or medications during that time?

7. I just asked about mental health services and resources that you needed to be able to access after your release, however, were there any mental health services and resources that you didn’t necessarily need to access but it would have been good to have access to? These can be things that are currently available or not.

8. How do you feel about using mental health services?

   1. Do you think that there’s a stigma around using this kind of care? Do you feel like other people judge those who use mental health services? Can you tell me more about that?
   2. Are you nervous about family or close friends finding out about you using mental health services or medications? Can you tell me more about that?
9. On your release, from corrections settings, did you feel that you had enough social support? From family? From friends? Other individuals or organizations in the community?

   1. What sources of social support would you like to have been better connected to? Example, if needed: family, support groups

10. Before we switch gears to talk about the app, is there something else you’d like to discuss that I haven’t asked you?

11. What experiences do you have with technology before being incarcerated? During? After?

12. Have you ever used technology for health purposes? Would you want to access your mental health records on a phone/app?

13. What should be included in the mobile app to support the mental health of Black women with a history of incarceration?

    1. What information do you think would be particularly helpful as they rejoin their communities? Information about…?

       1. Mental health services and resources?
       2. Other social services?
       3. Informal sources of support?
       4. Coping skills/strategies/activities?

14. Do you have any concerns about using the app? Example, if needed: privacy concerns

15. What would make you more likely to use the app?

16. What would make you less likely to use the app?

17. If you were designing the app, how would you get the word out about it?