Policy Changes to Improve Service Access: Best Practices for Researchers Engaging With Criminal Justice Partners

Abstract

The Texas Christian University Hub of the Justice Community Opioid Innovation Network Project includes a partnership with state criminal justice (CJ) agencies with the goal of impacting state- and local-level policies and practices that will lead to increased access to and retention in community-based substance use treatment services among parole clients. This article outlines how we successfully fostered policy changes and includes a five-step process for how researchers can bridge the gap between research and CJ agencies to implement similar changes. This process included the use of various strategies to support the justice partners in their efforts to implement changes within their organization.

Introduction

After release from incarceration, justice-involved (JI) individuals are at a heightened risk of misuse of opioids and other substances (Hoover et al., 2023), overdose, and mortality (O’Connor et al., 2022; Pizzicato et al., 2018). Compared with the general population, in the first 2 weeks after release from incarceration, JI individuals are more likely to overdose (Bukten et al., 2017; Hartung et al., 2023; Ranapurwala et al., 2018).

The Texas Christian University (TCU) Hub of the Justice Community Opioid Innovation Network Project aims to increase access to and retention in substance use (SU) and medications for opioid use disorder (MOUD) treatment among adults involved in the justice system who are reentering communities on supervised release and who are at risk of using substances upon reentry (see Knight et al., 2021). As part of this effort, we partnered with criminal justice (CJ) agencies in Texas (TX), Illinois (IL), and New Mexico (NM) to examine the implementation of two approaches to achieving system-level changes involving parole and behavioral health (BH) agencies across 16 communities.

CJ systems are known for their complexity and strict guidelines to maintain their operations (Bureau of Justice Statistics, 2021). The institutional capacity of CJ systems leaves very little time to focus on exploring practices outside of their normal realm (Grella et al., 2020; Johnson et al., 2003). In most cases, participating in research designed to improve operations tends to be particularly challenging, thus making it hard for research projects to impact the system and foster important policy changes. Changing the mindset about the importance of participating in research, understanding what research can offer the organization, and how research has the potential to inform policy are essential components for obtaining the support needed to produce research that will drive policy change within the CJ system.

Establishing Rapport

Establishing rapport with the CJ system and developing a research process that drives policy change are facilitated by a level of familiarity with how the CJ system operates, who the key players are, and knowledge of how to navigate the system. Building a research team that is inclusive of individuals who possess firsthand experience and has established relationships with key players can be effective in advancing research within CJ systems (Wurcel et al., 2022).

After key players are identified, effectively communicating research needs can be an important step toward overcoming barriers (Sullivan et al., 2017). Research team members who possess the ability to communicate with the CJ system in ways that are not overtheorized but framed in nonmethodological real-world terms (Blomberg et al., 2019) are critical for overcoming participation barriers. This, in turn, creates a mutual partnership between the research team and CJ staff. Understanding the system’s chain of command and hierarchy is an important step to establish rapport. Respecting how decisions are made within the CJ system begins with knowing who has the authority to impact organizational change (Sullivan et al., 2017).

Our strategy for establishing rapport began prior to the project being submitted for grant review, by conducting initial planning meetings that included a partnership with the parole division’s leadership team. Upon funding, we first approached the division-level leaders at the CJ agencies in TX, IL, and NM. During this initial meeting, we sought guidance on project aims and selected 16 communities based on study eligibility criteria as well as the division leader’s openness to research in their region. The workgroups comprised parole officers and supervisors and representatives from BH treatment providers located within each community. These meetings were followed by orientation meetings with workgroup members to clarify our research team’s role in the process, which was to serve as facilitators to help workgroups develop their own goals and action plans.

Our team included researchers who possess CJ work experience, specifically having previously established working relationships with key players within the system. This relationship provided us with a level of understanding that better equipped us to develop processes that were relatable to the CJ workgroup members. Developing relatable processes provided the staff participants with ease in an unfamiliar role of participating in research to implement system changes. This further enabled the participants to begin to understand and take a sense of ownership in what they were doing.

We collaborated with workgroup participants in a manner that encouraged substantive dialogue, which resulted in the development of goals and tasks that they were committed to put into action. Although the CJ staff were allowed to formulate their own ideas and identify tasks to implement new practices, there was still a level of curiosity about why they as parole staff were involved in promoting access to SU services. For instance, one workgroup member asked: “Why did they pick us to be in this project?”

This question presented an opportunity for us to share the value parole officers could bring to the research. We further explained that gathering information from the frontline perspective would help ensure policy changes that may occur would directly benefit them. Working with the CJ participants to gain an understanding of why they were taking on such an inclusive role in the project was important to the process in that it helped develop trust and eliminate doubts.

Our willingness to offer hands-on support to the workgroups allowed the participants to feel a part of the research process and not a subject of it. This, in turn, led the CJ participants to recognize how their involvement could benefit from what the research was seeking to offer, which was to promote system change as prioritized by workgroup members.

Once this realization was reached, CJ participants displayed a shift in attitudes about their participation and a valid interest to contribute to the process. One CJ workgroup member commented: “When we first started this, I really didn’t see how it was going to benefit us and was wondering why we were here, but now I get it … I see how it helps us.” In a specific instance, the staff added: “Y’all coming out and demonstrating how to use the Map [a tool developed by us to help CJ staff identify treatment resources in their community] really motivated us to want to do this.”

Steps to Leverage Policy Change

We engaged the workgroups in goal selection support (GSS) to formulate goals that could address service linkage gaps and local challenges identified in previous research activities (Fisher et al., 2018). Initially, workgroup participants were hesitant to discuss or identify goals and tasks that were realistic or impactful toward making meaningful changes. Their hesitancy resulted from a perceived lack of authority or influence to approve or initiate certain tasks. In some instances, their reluctance stemmed from doubting the ability of the research process to move any of their ideas forward. During the goal selection discussion, some workgroup participants expressed they thought the process would be a waste of time because the workgroup did not have the authority to put agreed-upon ideas into action. They were concerned about possibly being perceived by their leadership as complaining about their jobs.

Following study design, participants were engaged in a collaborative discussion that focused on how we could support the workgroups and address their concerns. Participants were allowed to speak freely about their concerns and offer recommendations to address concerns. Dialogue about possible solutions produced a consensus within the workgroups that policy change might be possible if someone from our research team (a credible “outside” entity) shared their ideas with their leadership. At the conclusion of the discussion, we built on the information CJ staff provided to incorporate a five-step process (see Fig. 1) into the workgroup’s coaching process.

Fig. 1.

Coaching process to support community workgroup implementation.

In collaboration with the Texas Department of Criminal Justice (TDCJ) for the six TX communities, this five-step process was implemented initially after the goal selection process. We convened to identify themes in goal and goal tasks across communities, resulting in us providing a summary of goals and tasks that were presented to TDCJ leadership using the following process.

Step 1: Identifying the Goal Tasks to Implement Immediately

The first step in the process involved collaborating with workgroup members to identify goal tasks that could be implemented immediately, without upper-level approval. As a result of this exercise, we identified 24 goal tasks potentially needing upper-level approval and that could potentially initiate policy changes if implemented. See Table 1 for two example tasks. Each task is connected to a specific community goal. Each community is numbered 1–6. For example, task 1 was prioritized for communities 1, 2, 4, 5, and 6, with community 3 stating that task 1 was important but did not add it to their goal action plan.

Table 1.

Example of Workgroup Action Plan Tasks Potentially Requiring Division/Executive Approval

#	Action plan tasks	C1	C2	C3	C4	C5	C6
1	Contract with detox centers to reserve beds for parole clients about to enter residential treatment or develop a memorandum of understanding	G1	G1	XX	G1	G1	G2
2	Approve and add a Narcan education training (e.g., when and how to use Narcan)	G6	G5	G5	G3

C, community number; G, goal number.

Step 2: Confirming Goal Tasks’ Approval Level

The second step of the process served two purposes: (1) demonstrating respect for the organization’s chain of command and (2) confirming tasks that could be approved at the regional level versus state approval. Regional staff for each participating community were asked to review the list of tasks and identify any that were in their level of authority to approve. They were provided a specified timeframe to offer feedback. In the case of this request, the regional staff chose not to provide feedback. If feedback were to have been received, we would have adjusted the list of tasks based on regional-level approval.

Step 3: Negotiating Approval for Goal Tasks

During step three of the process, we requested a meeting with the organization’s highest level of authority within their structure. In establishing this meeting, we initiated contact through phone communication rather than through email. This approach helped lessen the formality of the process and provided real-time opportunities to answer questions about the meeting request. The initial contact offered context as to why we were requesting a meeting and assessed whether there was interest in discussing state prioritization of goals and tasks. When interest was established, the formal process of getting the meeting scheduled occurred.

The formal process of setting up the meeting included allowing the director to determine the date, time, and location in an effort to respect their time. In this example, the director volunteered to send the meeting invite through their office protocol. Attendees at the meeting consisted of six members of the parole leadership team and three members from our research team. We presented the 24 goal tasks to parole’s division leadership. Six of the tasks received immediate approval, two required additional information, five were included in the organization’s 2030 plan, one was currently being piloted, three were not in the division’s level of authority, two were identified as existing in parole’s current policy, one the director agreed to review for consideration, and four were not discussed due to time constraints.

The meeting concluded with an agreement that we would share the meeting outcome with the workgroup members and provide the division leadership team any follow-up information obtained. We assumed this responsibility to support the workgroup and to prevent delay in the flow of information back to the CJ leadership team.

Step 4: Sharing Approved Goal Tasks

Goal tasks approved during the meeting included items such as conducting a stakeholder meeting inclusive of parole officers, BH providers, and other agency divisions to address service linkage challenges for parole and the BH providers, parole staff attending a Narcan educational training, attending MOUD training, approval to provide clients with resource material about Narcan, and development of a flyer for SU disorder (SUD) and opioid use disorder (OUD) providers to increase knowledge of services parole clients need and how to pursue CJ contract provider status.

The community coach, a member of our research team, had established rapport with the workgroup through previous project activities. After action plans were developed, workgroups identified one CJ staff member to serve as the workgroup liaison. The workgroup liaisons worked one-on-one with a community coach for the designated community and met with them at least monthly. The coaching calls served as both a check-in to see how action plans were progressing and an opportunity to collaboratively brainstorm solutions for challenges that had come up.

During the coaching calls and workgroup meetings, the coach shared approved tasks by first focusing on items the workgroup initially identified as a priority for their community. In some instances, the workgroups expressed interest in implementing additional goal tasks that were not initially considered due to a lack of identified state prioritization. The additional tasks were incorporated into the action plan to be implemented by the workgroup.

Goal tasks that required additional information for future discussion, such as the need to contract with detox and MOUD providers, were addressed through a collaborative discussion among the liaisons and our research team. The community coach scheduled a meeting with workgroup liaisons from each community to share the additional information requested. During this discussion, the community coach engaged the liaisons in a discussion about the topic, which produced rich dialogue that led to identifying a need to implement these services in some areas and to also utilize detox facilities as a preventive alternative to sending clients back to prison when they relapse or test positive during drug testing.

Step 5: Putting Tasks Into Actions

We supported workgroups in their efforts to put tasks into action through the use of various coaching strategies. Strategies included, but were not limited to, monthly coaching calls conducted by the community coach with the liaison to discuss the workgroup’s progress, attending workgroup meetings as requested, following up with the workgroup’s leadership, providing feedback on processes implemented by workgroups, identifying training resources, and developing instructional materials for the workgroups.

Workgroup liaisons collaborated with the community coach to implement a plan-do-study-act (PDSA) process used in a prior TCU study funded by the National Institutes of Health (Knight et al., 2016) that could be shared with their workgroups to implement tasks. The PDSA process allowed liaisons to develop steps for specific tasks rather than focusing on the broader action plan. The PDSA worksheet was an optional tool the liaisons could use, and many chose to utilize it as a guide. The PDSA process was presented individually to the liaisons, starting with the PLAN worksheet. This allowed the liaisons to get comfortable using the tool without focusing on the full concept of the PDSA process.

The liaisons, in collaboration with the coach, brainstormed about the type of information that could be included in a PDSA cycle and how to use it with their workgroups. A set of PDSA worksheets was completed for each task selected by the workgroup to implement. This approach allowed the liaison to present the information to the workgroups in a manner that targeted specific tasks as opposed to a broad list of goal tasks.

The liaison worked with workgroup members to identify planning resources available to complete tasks and how progress would be monitored. This included assigning specific steps for workgroup members to work on with a targeted completion date. Utilizing the tool in this manner provided the liaison with a structured method to keep the workgroup on track with the goals and to help prevent overwhelming them, thus producing an area of focus that seemed attainable.

Policy Impact

We were able to obtain approval for goal tasks designed to address some of the challenges identified during GSS. Three examples of challenges addressed by these goal tasks are provided below: limited interagency communication and collaboration, limited community provider options, and lack of knowledge on the purpose and value of MOUD and Narcan.

Limited Interagency Communication and Collaboration

Interagency collaboration between parole and BH was identified as a common challenge in promoting service linkage for individuals on parole. Workgroup members believed this challenge could be addressed by implementing agency-led stakeholder meetings with parole, BH providers, and other CJ agency divisions. This action step was presented to the parole division’s leadership team and was approved. With this approval, the parole division director volunteered to take a lead role in the process since it required involvement from other leaders within the agency.

Limited Community Provider Options

Limited service provider options to refer parole clients in the community were another common goal focus across communities. The task proposed by the workgroups included developing a flyer for SUD and OUD treatment providers to increase knowledge of services clients need and how to become a contracted vendor. This task was presented to parole’s leadership team and received approval. The leadership team made the recommendation to use the division’s attendance at an upcoming state SU conference to distribute the flyers. This conference has a large attendance of BH providers. Having additional BH provider options as a result of this process is expected to increase client access to necessary services.

Lack of Knowledge on Purpose and Value of MOUD and Narcan

Many community workgroups identified a need to add naloxone (brands Narcan and Evzio) and MOUD education training for parole staff. This action step was presented to the leadership team and was approved with some exceptions. The leadership team felt it was beneficial for the therapeutic community officers and supervisors to receive MOUD training and parole supervisors to receive naloxone training. Although immediate approval was provided for specific positions, other staff could attend by making a request through their agency’s training request and approval process.

Summary

Ultimately, we succeeded in implementing several key policy changes the workgroups identified as a need. Examples include agency-led stakeholder meetings with parole, BH providers, and other agency divisions to improve interagency communication and collaboration; development and distribution of flyers to inform additional contracted vendors about services needed for parole clients; and identifying and participating in training programs to increase knowledge and awareness of the need for MOUD treatment and Narcan availability for parole clients.

Authors’ Contributions

A.L.W.: Conceptualization, writing—original draft, and writing—review and editing. P.D.C.: Conceptualization, writing—original draft, and writing—review and editing. J.E.B.: Writing—review and editing. C.W.: Writing—review and editing. K.K.: Writing—review and editing.

Disclaimer

Interpretations and conclusions from this article are entirely those of the authors and do not necessarily reflect the position of National Institute on Drug Abuse, National Institutes of Health (NIDA/NIH) or the NIH HEAL Initiative.

Author Disclosure Statement

The authors disclosed no conflicts of interest with respect to the research, authorship, or publication of this article.

Funding Information

NIDA/NIH, through a grant to Texas Christian University (DA050074), provided funding for this article.