Shannon Gwin Mitchell1, Caroline Harmon-Darrow2, Elizabeth Lertch3, Laura B Monico4, Sharon M Kelly5, James L Sorensen6, Robert P Schwartz7. 1. Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA. Electronic address: smitchell@friendsresearch.org. 2. University of Maryland Baltimore School of Social Work, 525 W Redwood St, Baltimore, MD, USA. Electronic address: CHARMON@ssw.umaryland.edu. 3. Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA. Electronic address: elertch@friendsresearch.org. 4. Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA. Electronic address: lmonico@friendsresearch.org. 5. Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA. Electronic address: skelly@friendsresearch.org. 6. UCSF Department of Psychiatry and Behavioral Sciences at Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, SFGH Building 20, Rm. 2117, San Francisco, CA, USA. Electronic address: James.Sorensen@ucsf.edu. 7. Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, USA. Electronic address: rschwartz@friendsresearch.org.
Abstract
BACKGROUND: Patient navigation has potential for assisting patients who initiate methadone during pretrial detention to enter and remain in treatment following release, but we know little about participants' experiences with this service. METHODS: This study drew a purposive sample of male and female participants (N = 17) from participants enrolled in a randomized trial of initiating methadone with vs. without patient navigation while in the Baltimore City Detention Center. The study interviewed participants in the community at 1 and 3 months following release and asked them about their experiences of reentry, methadone treatment continuation, drug use, and interactions with the patient navigator. The study recorded, transcribed, coded using Atlas.ti, and analyzed thematically the interviews. RESULTS: Participants reported encountering four key challenges in the community: getting to treatment following release, assembling basic supports, managing criminal justice system demands, and staying in treatment. Participants' experiences of the patient navigator's support to address these challenges fell into six thematic groups: showing nonjudgmental caring and persistence, advocating within programs, brokering resources, managing interactions with the criminal justice system, balancing encouragement and self-determination, and offering genuine and familial-type support. CONCLUSION: Nearly all participants appreciated the navigator's support and deemed it helpful. The previously reported randomized trial found that participants assigned to initiate methadone treatment with navigation had higher rates of receiving their first "guest" methadone dose in the community but did not have significantly different rates of treatment enrollment or of illicit opioid use compared to those assigned to begin methadone treatment without navigation. Treatment programs should work to improve retention and postrelease outcomes among this population.
BACKGROUND: Patient navigation has potential for assisting patients who initiate methadone during pretrial detention to enter and remain in treatment following release, but we know little about participants' experiences with this service. METHODS: This study drew a purposive sample of male and female participants (N = 17) from participants enrolled in a randomized trial of initiating methadone with vs. without patient navigation while in the Baltimore City Detention Center. The study interviewed participants in the community at 1 and 3 months following release and asked them about their experiences of reentry, methadone treatment continuation, drug use, and interactions with the patient navigator. The study recorded, transcribed, coded using Atlas.ti, and analyzed thematically the interviews. RESULTS: Participants reported encountering four key challenges in the community: getting to treatment following release, assembling basic supports, managing criminal justice system demands, and staying in treatment. Participants' experiences of the patient navigator's support to address these challenges fell into six thematic groups: showing nonjudgmental caring and persistence, advocating within programs, brokering resources, managing interactions with the criminal justice system, balancing encouragement and self-determination, and offering genuine and familial-type support. CONCLUSION: Nearly all participants appreciated the navigator's support and deemed it helpful. The previously reported randomized trial found that participants assigned to initiate methadone treatment with navigation had higher rates of receiving their first "guest" methadone dose in the community but did not have significantly different rates of treatment enrollment or of illicit opioid use compared to those assigned to begin methadone treatment without navigation. Treatment programs should work to improve retention and postrelease outcomes among this population.
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