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报告摘要

CO-SHARE Study Summary

Core Content

The Co-Design of Services for Health and Reentry (CO-SHARE) project is a pilot study conducted in Los Angeles County that used the Experience-Based Co-Design (EBCD) method to improve health and reentry services for individuals returning to the community from jail. This study aimed to bridge the gap between service users and providers by involving both groups in a collaborative design process.

Main Objectives

To identify key needs and priorities for health and reentry services from the perspectives of returning citizens and service providers.
To co-design solutions for improving these services.
To develop lessons on how to adapt EBCD for use in a community-wide system in the United States.
To support the integration of returning citizens into the community and reduce recidivism.

Key Information

Participants

54 returning citizens: Adults from the South LA area, released from jail within the year prior to the study, with mental health, substance abuse, or chronic/serious physical health conditions.
23 service providers: Representing 11 agencies in LA County, including county government agencies, a regional reentry coalition, and community-based organizations (CBOs).

Study Design

Conducted from August 2017 to late 2018.
Involved a multistep, group-facilitated EBCD process.
Three phases:
1. Gathering experiences: Focus groups, interviews, and a short film made by returning citizens.
2. Identifying priorities: Joint discussion between returning citizens and service providers to identify four high-priority topics.
3. Co-designing solutions: Forming workgroups for each topic to recommend improvements.

High-Priority Service Topics

Prerelease Process
One-Stop Service Hubs
Housing
Long-Term Support

Key Recommendations

Prerelease Process

Improve connections with services before release.
Enhance CBO access to jails for early engagement.
Ensure direct meeting with trusted service providers upon release.
Utilize innovations like service hotlines and videoconferencing for continuity of care.
Provide mobile phones and a reentry app to assist with the process.
Improve communication among service providers to better coordinate support.

One-Stop Service Hubs

Offer a wide range of services in one location.
Include both county agencies and CBOs.
Cover court-ordered services, basic needs, housing, employment, health, family support, legal issues, and social support.
Locate hubs outside probation facilities to increase comfort and accessibility.
Link hubs closely with the prerelease process for seamless support.

Housing

Create affordable, safe, and long-term housing near work and family.
Repurpose unused buildings, such as former juvenile facilities.
Build relationships with landlords and provide support for returning citizens.
Increase the number of homeless liaisons and provide updated training.
Promote peer-to-peer sharing and mentoring for housing navigation.
Include court co-located advocates for housing assistance.

Long-Term Support

Provide continual access to reentry navigators for personalized planning.
Develop formal peer and mentor support programs.
Leverage housing and other service improvements to support long-term integration.
Advocate for policies that ease criminal record expungement and support reentry.

Lessons Learned

Successes

The EBCD process was effective in engaging both returning citizens and service providers in a collaborative environment.
The use of a "trigger" film and group-facilitated activities empowered participants.
Participants reported that the process built trust and familiarity over time.

Adaptations

The study adapted EBCD to a community-wide context, involving multiple agencies and locations.
Adjusted recruitment and scoping to reflect the diversity of participants and services.
Used facilitation techniques tailored to the needs of returning citizens.
Reduced the size of co-design workgroups to improve focus and participation.

Limitations

The spatial and organizational complexity of the service systems made it difficult to implement concrete improvements.
High transience among returning citizens and the reentry period itself posed challenges to participant retention and engagement.

Conclusions and Next Steps

The CO-SHARE study demonstrated the feasibility and value of EBCD in a U.S. community-wide setting for improving health and reentry services. It provided comprehensive insights into the needs and priorities of returning citizens and service providers, and highlighted the importance of collaboration, empowerment, and system-wide coordination.

Next Steps

Disseminate recommendations, resources, and lessons learned from the study.
Explore follow-on EBCD projects to implement and scale the identified solutions.
Continue to adapt EBCD for other vulnerable populations and service areas.

Key Takeaways

EBCD is an effective method for involving service users and providers in co-designing community-based services.
Returning citizens face significant barriers to accessing and coordinating services, including stigma, lack of resources, and fragmented systems.
Collaborative and inclusive design processes are essential for creating equitable and sustainable service improvements.
System-level changes are necessary to address the interconnected challenges of health and reentry support.

Acknowledgments

The study was supported by the Robert Wood Johnson Foundation (Grant No. 74212). The success of the project was due to the willingness and commitment of participants, service providers, and the study team. The RAND Corporation and Los Angeles Metropolitan Churches collaborated closely to implement the study.