Access to Health Care and Treatment Among Individuals Convicted of Sexual Offenses Paroled to Urban and Rural Communities

Published date01 July 2021
AuthorBeth M. Huebner,Breanne Pleggenkuhle,Kimberly R. Kras
Date01 July 2021
Subject MatterArticles
CRIMINAL JUSTICE AND BEHAVIOR, 2021, Vol. 48, No. 7, July 2020, 964 –980.
Article reuse guidelines:
© 2020 International Association for Correctional and Forensic Psychology
University of Missouri–St. Louis
Southern Illinois University–Carbondale
San Diego State University
Returning from prison to the community is rife with challenges. For individuals with health care, mental health, or substance
abuse treatment needs, the reentry period can be especially vulnerable. Furthermore, these services are not evenly distributed
across communities. This study explores barriers to health care and treatment among individuals convicted of sexual offenses
who are returning from prison to urban and rural communities. Using data from in-depth interviews and geographic data, our
analysis highlights the needs of this population that is often mandated to treatment. Access to treatment and health care is a
challenge for many participants and is exacerbated in rural areas because of a dearth of providers and the long distance to
treatment offices. The results highlight the deficiency of treatment services across the urban–rural continuum and support
new innovations in service provisions.
Keywords: reentry; treatment; sex offenses; transportation; rural; health care
Many Americans face barriers to health care including the approximately 1.5 million
currently serving time in prison (Carson, 2019). Incarceration extends and deepens
health care disparities (Massoglia, 2008). Individuals who have been incarcerated are more
likely to experience health problems than the general public, and the conditions of confine-
ment and process of reentry from prison to the community can negatively affect long-term
physical and mental health (Fahmy & Wallace, 2018; Link et al., 2019; Loeb & AbuDagga,
2006; Massoglia & Pridemore, 2015). This population also has very high rates of substance
use and many are mandated to treatment in the community, but institutional care is sparse
AUTHORS’ NOTE: Thank you to Ted Lentz for research assistance on this project. The opinions and conclu-
sions expressed in this article are those of the authors and do not necessarily reflect the Department of Justice.
This work was supported by the National Institute of Justice under Grant [2008-DD-BX-0002]. Correspondence
concerning this article should be addressed to Beth M. Huebner, Department of Criminology and Criminal
Justice, University of Missouri–St. Louis, One University Blvd., St. Louis, MO 63121; e-mail: huebnerb@
972747CJBXXX10.1177/0093854820972747Criminal Justice and BehaviorHuebner et al. / Access to Treatment in Rural and Urban Communities
and there are substantial treatment gaps in the community (Bronson et al., 2017; Sung et al.,
2011). Individuals returning from prison often lack access to material resources, like trans-
portation, that facilitate connections to medical care and treatment (Bohmert & DeMaris,
2018; Wakefield & Uggen, 2010).
Mental health and substance abuse programming and health care services are not equally
distributed across communities, and characteristics of place, like rurality, shape health out-
comes (Monnat & Beeler Pickett, 2011; Weinhold & Gurtner, 2014; Wodahl, 2006). There
is ample evidence to suggest that individuals living in rural areas have a lower life expec-
tancy and poorer health overall (Kroneman et al., 2010; Singh & Siahpush, 2014), but these
studies have not been replicated with populations on parole. Most work on reentry has
focused on individuals returning to urban communities, and very little is known about the
process of reentry in rural contexts (see Wodahl, 2006), and even less about the treatment
needs and health outcomes of rural residents on parole.
Furthermore, most scholarship on access to treatment and health care among formerly
incarcerated persons has been conducted using general parole samples, but there is cause to
believe that the nature of the conviction, and the associated requirements for compliance on
parole, may condition the relationship. Individuals with a sex offense conviction are a
unique analytic case as participation in cognitive-behavioral treatment is often a condition
of parole (Kras et al., 2018; Savage & Windsor, 2018). Furthermore, persons convicted of a
sex offense face considerable stigma and have low social status (Huebner et al., 2019), an
important correlate of negative health outcomes (Marmot, 2004). Understanding the barri-
ers to health care and rehabilitative services has the potential to benefit individual and com-
munity health and may help people comply with mandated programming, which has been
associated with reduced rates of recidivism and long-term success (Kim et al., 2016;
Schmucker & Lösel, 2017).
This article considers the structural and spatial differences in access to treatment, broadly
conceptualized to include mental health and substance abuse programming and other reha-
bilitative services that are often mandated by court and correctional agencies, and health
care among individuals convicted of a sexual offense and extends research in several ways.
We document the prevalence and nature of health and treatment needs among a sample of
individuals paroled for a sexual offense and consider how these experiences vary for urban
and rural residents. By analyzing interviews and geographic data from a sample of 62 men
and women released on parole for a sexual offense, this work highlights several barriers to
effective service provision that could be addressed through responsive and boundary span-
ning correctional policy.
Although incarcerated persons are traditionally omitted from larger population health stud-
ies, researchers have documented the substantial need for mental and physical health care
services and substance abuse treatment among this population (Fahmy & Wallace, 2018). For
example, incarceration increases the likelihood of major depressive symptoms while impris-
oned and after release, with rates approximately 2 times higher than nonincarcerated popula-
tions (Massoglia, 2008; Turney et al., 2012). Researchers found that 50% of incarcerated
individuals report a chronic health condition (Maruschak & Berzofsky, 2015), and upward of

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