Abstract
This paper describes the post-incarceration reintegration experiences of military veterans convicted of sex offenses and identify potential interventions to ease reintegration for this population. Participants were a convenience sample of 14 veterans who were on sex offender (SO) registries and 21 community stakeholders involved in supporting persons during re-entry. Subjects were identified purposively and through snowball sampling, in Massachusetts. We employed semi-structured qualitative interviews of participants, followed by analysis including process mapping to identify barrier and facilitation points. We used both a grounded thematic approach and a priori codes, guided by the Behavioral Model for Vulnerable Populations. We found re-entry barriers include older age, stigma, lack of social support, inadequate information about sexual offense levels, limited housing options and access to mental health treatment to reduce sexual impulses, and re-entry information tailored to SOs. Re-entry facilitators include access to SO treatment, knowledge about services, self-efficacy, ability to self-advocate, and social support. Interventions to aid successful re-entry include pre-release counseling and classes tailored to SO needs, re-entry planning including housing resources, sexual deviance treatment, and referral to legal counseling to assist with altering assigned SO level. Specific needs and resources unique to veterans should be integrated into reentry plans. Convicted SOs often lack information and assistance to prepare for life after release, putting them at increased risk of homelessness, emotional difficulties, and financial hardship. Failure to recognize the unique needs of this population, and to leverage resources, creates a public health risk as it increases the likelihood that SOs will recidivate. Veterans who are SOs have unique resources available to them through the Veterans Administration such as SO treatment and peer-support specialists. Nevertheless there are additional steps that could be beneficial, such as timely provision of information, creating more opportunities for treatment, and providing more housing options.
Introduction
Individuals convicted of a sex crime have an increased likelihood of experiencing homelessness and emotional and financial hardship (Levenson, 2008; Levenson & Cotter, 2005). This presents a public health risk as it increases the likelihood that these citizens returning to the community from jails and prisons will commit another sex crime. Levenson et al. found that those persons convicted of a sexual offense who have social support and stable employment are less likely to recidivate (Levenson, 2008). Additionally, while rates of recidivism are low among people convicted of a sexual offense (5%-14%), a meta-analysis by Hanson and Bussiere (1998) demonstrated that with mental health treatment designed to control sexual impulses, the likelihood of recidivism is reduced by half. But, many of the policies intended to keep the public safe from those who have committed sexual offenses have an unintended consequence of making an individual more likely to reoffend due to social isolation (Freeman-Longo, 1997; Gavrilets et al., 2016; Hanson & Bussiere, 1998; Levenson, 2008).
Addressing the needs of persons convicted of a sexual offense has special importance for the Department of Veterans Affairs (VA) because veterans are disproportionately more likely to be convicted of a sex crime than the general population. Veterans make up 8% of the incarcerated population and there is a lower rate of incarceration among veterans than nonveterans (855 per 100,000 compared to 968 per 100,000) (Bronson et al., 2015). However, within the incarcerated population, veterans who are sex offenders (SOs) are overrepresented. Nationally veterans convicted of a sexual offense (VCSO) make up about 35% of incarcerated veterans in prisons and 12% of incarcerated veterans in jails compared to 23% of nonveterans in prison and 5% of nonveterans in jails who have been convicted of a sexual offense (Bronson et al., 2015). Veterans have 1.35 greater odds of being convicted of a sexual offense than a nonveteran (Finlay et al., 2019). Veterans convicted of a sex offense are also more likely to experience housing instability (OR 1.81, 95% confidence interval [CI] 1.46–2.25), homelessness (OR 2.97, 95% CI 1.67–5.17) (Byrne et al., 2020) and to have been forced to have had sex (OR 4.43, 95% CI 3.55-5.54) (Finlay et al., 2019). And men among the military more generally are more likely to have been a victim of sexual abuse before the age of 18 (OR 2.19, 95% CI, 1.34-3.57) among other adverse childhood experiences (Blosnich et al., 2014).
Veterans are also an especially vulnerable population. Veterans leaving incarceration generally are more likely to be older and sicker than their civilian counterparts (Eibner et al., 2016). They are also more likely to have mental health problems, traumatic brain injury, substance use disorder and are more likely to commit suicide (Olenick et al.,2015). Despite this, they have services available through the VA that other populations do not.
When veterans return to the community after incarceration, they need to be engaged in services upon release in order to reduce their risk of homelessness and reoffending, as well as address other mental and physical health problems common to veterans. There are unique services for veterans leaving incarceration: within the VA, reentry planning for all veterans leaving incarceration, including those who are required to register as an individual convicted of a sexual offense, is primarily the responsibility of counselors within the national Health Care for Reentry Veterans (HCRV) program (VHA Health Care for Reentry Veterans (HCRV) Program Handbook, 2014). A 2015 national survey of these HCRV providers found that housing for SOs is the number one unmet need among reentry veterans (Office of Public Affairs and Media Relations, 2015). However, despite the high level of need, the unique vulnerability and resources specific to this population, and the positive impact successful reintegration can have both for the veteran and for public safety, there is little literature specifically on veteran experiences in the first months after release from incarceration. While there has been qualitative research on reentry with those convicted of a sexual offense among the general population, there is scant literature on the barriers to, and facilitators of, successful reintegration into the community for veterans specifically. Our research aimed to better understand for veterans what unmet needs exist in the reentry process. We were guided by the following research questions:
What are the most significant barriers to housing, employment and health care that are specific to reentry VCSO? What are some of the facilitators in use by the VA, state, and community organizations to overcome the barriers faced by VCSO?
This work was conducted in the context of a VA initiative to improve support and linkage to services for reentry veterans, and as such was designed to identify potential best practices that would improve reentry processes and outcomes for VCSOs. The larger VA initiative has been described elsewhere (Simmons et al., 2017).
Methods
Overview
We used qualitative semistructured interviews because of the strength of this method in the early exploration of a topic (Yin, 2015). The qualitative approach gives “permission” to respondents to guide the discussion to areas that are of high importance, which may not have been specifically mentioned in an interview question. We conducted interviews with VA HCRV counselors and staff, state officials and reentry program managers, community care providers, and veterans who were convicted of a sex offense to more fully understand barriers and facilitators to community reintegration after incarceration, including such issues as housing, behavioral health, and access to treatment in this subgroup of reentry veterans. In addition to analyzing data to identify major themes, we also used these interviews to construct a process map (Figure 1) for veterans on an SO registry leaving incarceration to depict the common pathways that VCSOs follow during the first 4 to 6 months postrelease. The study was designed to identify areas in which the VA could improve services to address the needs of veterans who had been incarcerated, including veterans with sex offenses. It was submitted to the Institutional Review Board (IRB) at the Edith Nourse Rogers Memorial Veterans Hospital (Bedford, Massachusetts, USA), which determined it was a quality improvement project as per VA handbook 1200.05. The need for continued IRB review was waived. Verbal informed consent was obtained from all participants.
Process map of VSOs leaving incarceration. The map includes a start and finish for the process (indicated by blue circles), potential intervention points (indicated by yellow triangles), decision points (indicated by green diamonds) and action points indicated by red rectangles.
Interview Guide
When developing our interview guide, we drew on the behavioral model for vulnerable populations (BMVPs), developed by Gelberg et al. The BMVP describes the barriers and facilitators of service utilization by highly vulnerable groups such as persons who are homeless, persons with substance use and mental health disorders, as well as persons with a history of incarceration (Gelberg et al., 2000). We chose this model because our research questions are designed to help develop interventions to improve the health of veterans who are in an environment in which frayed social structures may engender unstable housing and homelessness, high crime rates, and high prevalence of mental illness, substance use disorders, and infectious diseases. Our interview guide encompassed questions about the process of leaving incarceration, experiences of individuals leaving incarceration and an opportunity to recommend steps that would have eased the transition.
Interviews
The interviews were conducted October 2016 to July 2017. Stakeholders and veterans were interviewed once and interviews lasted 30-90 minutes. We achieved data saturation which means that additional interviews yielded no new relevant information. It is used to strengthen the validity of our results (Yin, 2015). Interviews were audio recorded and transcribed.
Setting and Study Sample
This project was conducted in Massachusetts, with interviews seeking to gain perspectives from a wide variety of agencies and organizations involved in policies, programming, and service delivery for veterans undergoing reentry. We chose this sample because we were seeking to identify resources specific to veterans.
We first used purposeful sampling, a method in which participants are identified based on their knowledge or role in an organization (Yin, 2015), to identify and interview persons who were most knowledgeable about VCSOs, and especially with knowledge of the processes and experiences of VCSOs. There are six main categories from which we sampled: VA entities, state agencies (e.g., Department of Corrections, Department of Veterans Services), community organizations (e.g., transitional housing and shelter programs targeting veterans, and similar programs targeting the general homeless and reentry population), peer support specialists, VCSOs, and leadership of the national HCRV office. We then used snowball sampling (Yin, 2015) to identify veterans and additional stakeholders. Veterans in particular were only suggested for inclusion by stakeholders specifically. Snowball sampling can be especially useful for research into socially sensitive topics. Veterans were given a $25 CVS gift card for their time, while other interview participants were not compensated.
For veterans inclusion/exclusion criteria are having been released from a Massachusetts state prison, or jail, being on the SO registry, and eligible for Veterans Health Administration (VHA) services. We did not restrict our sample by SO level. There are three SO levels in Massachusetts: Level 1 includes individuals who “have a low risk of reoffending, pose a low degree of danger to the public.” Level 2 includes individuals who “have a moderate risk of reoffending, pose a moderate degree of danger to the public.” Level 3 includes individuals who “have a high risk of reoffending, pose a high degree of danger to the public.” For level 1, information about the offender can only be accessed by law enforcement agencies and state social service agencies and not the public. For level 2, information on anyone classified after July 12, 2013 is publicly available on the online registry, while for level 3, information is available through local police departments and the online registry. History of dementia and other serious cognitive impairment were exclusionary criteria.
Analysis
Interview audio-recordings were transcribed verbatim by a professional transcription service and analyzed using NVivo, a qualitative data analysis software (QSR International Pty Ltd., 2014). A codebook was developed iteratively by two members of our research team (MS, KR), with two levels of coding beginning with open coding. Open codes capture recurring relevant information and are closely related to source data. We then conducted categorical coding, which is a higher conceptual level of coding that takes into account similarities across codes (Yin, 2015). Codes were both deductive and inductive. The former were a priori codes based on interview questions, while the latter codes emerged from the data. A priori codes based on interview questions were drawn from BVMP constructs and literature relating to vulnerable populations’ housing issues, needs, services, and engagement (Gelberg et al., 2000; Stein et al., 2007). Within this coding scheme, we considered veterans status specifically and included an a priori code to reflect this. Three members of the project team coded the data (MS, KR, TL). The process started with 5 of the transcripts being separately coded by each of the three team members and then discussed in a team meeting to identify and resolve discrepant approaches to coding. This resulted in a consensus on the use of the codes and helped to improve consistency in coding across coders. The remaining transcripts were then divided among the three coders for completion of coding. After coding was completed, the team met to develop themes from the categorical codes, a process in which the codes were arranged hierarchically (Yin, 2015) (grouping open codes under one or more categorical codes), and then conceptually similar categorical codes were grouped into themes.
Analysis of qualitative data contributed to the first aim, which was the creation of a process map which helped to identify where in the reentry process there were bottlenecks, confusing steps, or other barriers in the way that VCSOs transition back into the community, and, consequently, opportunities for improvement or intervention (Simmons et al., 2017). To create the process map, the timing, sequence, and duration of Veterans’ contacts with individuals and organizations were diagrammed to show the whole network of reentry-related contacts made (Lyalin & Williams, 2005), services used, and barriers encountered, by VCSOs. Such maps may also reveal unproductive steps or contacts, long waiting periods between contacts, and useful but infrequently tapped resources (Kim et al., 2019). Team members met and developed the process map together in a consensus building and collaborative process (Gavrilets et al., 2016) facilitated by one member with experience in this technique, using sticky-notes flipcharts to create “draft” versions, and then revisions, of the process map. This map was intended as a tool for the research team to identify specific intervention points.
Results
Description of the Sample
We completed interviews with 14 veterans and 21 stakeholders. Among stakeholders were VA employees, and the rest were affiliated with state and local organizations. Approximately half of the interviewed stakeholders served in supervisory roles at their organizations, with the other half serving more front-line program delivery roles. Approximately half of the interviewed stakeholders were female. Among VCSO participants, all were male and ages ranged from 50 to 70 years. We included more stakeholders than veterans due to the diverse roles of the stakeholders.
Themes
We grouped major themes into two categories: barriers to reintegration and facilitators to reintegreation. In barriers, major themes were older age, stigma, lack of knowledge about resources and services, limited housing options, lack of social support, lack of treatment programs to address sexual impulses, confusion, and lack of information about the process of assigning a sexual offense level to an offender. Themes categorized as facilitators were access to SO treatment (especially services offered through the VA), knowledge about services, self-efficacy and ability to self-advocate, and social support (especially in the form of other veterans). These are described in more detail below.
Barriers to reintegration
Age.
All but two of the veterans in our sample had been incarcerated for years or decades due to the nature of their crimes. This meant that they were of advanced age when leaving incarceration. This exacerbated many of the challenges of leaving incarceration. For instance, several participants explained how they did not know how to use a smart phone or automated banking systems. Many also discussed their age in relation to their potential for employment, with some deciding not to participate in the workforce at all and others wondering what kinds of jobs they might be able to secure given the combination of their age, offense, and general lack of work history.
Stigma.
I think families want to be able to do that, [provide social support] and want to be able to embrace folks [veteran sex offenders], but they are leery. I mean, it may be as specific as being very supportive and helpful but being nervous about them being around the young cousins or whatever. And then the other part is, people obviously have their visceral reaction to thinking about whatever the crime or the allegation was. And so, I think that that level of support, that often we get from families or friends or whatever, can be really compromised or confusing, I think, with this population.
This stigma can also be more overt. For instance, VCSOs described having houses and cars vandalized and being harassed in shelters. One veteran described how he was hired for a job and then the offer was rescinded when he disclosed that he was on the SO registry for previous crimes. The stigma also can distort the way other people view the crime. Here a level 1 (lowest risk level) VCSO described the ostracism and vilification he felt. It should be noted he was not describing his own sexual offense in the following quote:
We committed a crime. A horrible crime, pled guilty, we’re sentenced, and we’re punished for that crime. Now when we get out, we’re on probation, a continuance of that punishment. We have to register, another continuance, we wear a GPS monitor, the stigma, the family, isolation, all of these things. And then on top of that you got people that are just going to hate you because the second you say, “I’m a sex offender,” they automatically assume you held some little three-year child down and brutally raped them and killed them. That’s in their minds automatically. When it could have been something as simple as you got drunk on the way home, you’re walking; you stopped behind a bush to urinate and happened to be in front of a school at nighttime. And it’s closed but a cop sees you and [snapping fingers] you’re a sex offender.
While stigma is a consistent issue throughout the reentry process, there are also specific points when it is particularly crippling, such as when trying to access housing and treatment, and its contribution to social isolation, as described in the sections below.
Lack of knowledge.
This is another theme that cuts through many aspects of the VCSO experience and is a consistent barrier. While lack of knowledge of resources is a near-universal problem for those who have been incarcerated, the stakes are higher for persons who have a criminal history that includes a sexual offense and they also have unique needs – thus generic resource packets for ex-offenders may be less helpful for them. Especially for veterans, there are resources for VCSOs that can be particularly helpful that are not available in generic reentry planning. Also, knowledge and skills to secure resources are also a barrier that reentry veterans encounter upon release. There are several programs designed to help people leaving incarceration but veterans often discussed they did not know about programs when they were released. For instance, one VCSO was in transitional housing and during that time the caseworker he met there told him about how he qualified for food stamps. Another described how he learned how to procure donated clothes and furniture. VCSOs reported that knowing this information at the time of release would be helpful.
It is unclear from our sample if this lack of knowledge was due to a lack of communication or because individuals were overwhelmed by the information they were given. Additionally, some participants reported that the counselors at the VA and the Department of Correction (DOC) did not always fully communicate with each other, which meant they were given information twice, contributing to feeling overwhelmed by the amount of information provided upon reentry. Veterans in our sample recommended that having a short packet of information tailored specifically for VCSOs might be helpful to mitigate this.
Lack of social support.
While lack of social support is prevalent among all types of offenders, it appears to be particularly acute among VCSOs as compared to other justice involved veterans. This is likely due to the stigma and fear that the SO label brings with it in society. Some veterans reported feeling rejected by family members, while others reported being taken advantage of by family members. For instance, this veteran described reaching out to a cousin he had been close to his entire life:
So, I called [from prison] and the telephone says, “this phone call is originating from a penal institution” or something like that, and I heard his wife answer the phone and after it said that, “click.” So, that was a kick in the head.
He went on to describe the isolation that he felt after that call and how it was a setback for him. This isolation can also cause a situation where family members take advantage of the reentry veteran. One caseworker told us about one VCSO who lost over $100,000 to family members to whom he had given control over his finances while he was incarcerated. Other veterans described similar disappearance of their money at the hands of family members.
Housing.
Limited access to housing is another major barrier for VCSOs especially as compared to other justice involved veterans. While some of the veterans we interviewed were fortunate to own a home, or have family that was willing to take them in, the majority struggled to secure safe housing. Adequate housing is pivotal to successful reintegration as described by a caseworker:
if they don’t have a place to go, if they’re gonna go underground and they’re not gonna register, they’re gonna be floating from place to place, and if they reoffend then there’s gonna be public outcry. But if there were places to have people like that go to have a fair chance at starting their lives back over again…
Respondents noted that homeless shelters generally would accept those on SO registries, but that few long-term low-income housing programs would. In Massachusetts, stakeholder respondents reported there are only three temporary housing facilities that can house persons required to be on the SO registry. They also noted that cannot live in public housing while on the registry and cannot receive federal housing assistance while on the registry. Veterans and stakeholders also reported that at the local level, municipalities often have different rules about where an individual who is on a SO registry may live and work, making it difficult to abide by all rules. Participants noted that localities prohibit registered individuals from living near schools, parks, and public buildings but that there is not a consistent state-wide law that governs this. Respondents indicated that some veterans choose to flout the rules because the limited availability of housing left them with no other option. But respondents reported these municipal regulations can severely limit housing options for SOs. Participants who were able to find housing in the private rental market reported that because of their limited financial resources they often could only afford shared living arrangements and often the housing was substandard including poorly maintained or rodent infested.
Stakeholders reported that one of the most significant barriers to housing was the federal prohibition on using federal housing funds, such as Section 8 vouchers, for individuals who were required to be life-time registrants on the SO list. In Massachusetts this is level 3 SOs. However, municipality specific housing authorities may have additional prohibitions for anyone on a SO list, further complicating this issue. The VA does not have any long-term or transitional housing for VCSOs, though they do have residential SUD treatment facilities that will accept VCSOs. Caseworkers also reported that nursing homes in Massachusetts will not take individuals with a criminal history of sexual offenses which is particularly problematic because many of them have been incarcerated for many years, are old and often frail.
Finally, stigma and societal fear can also contribute to housing barriers for individuals who have been convicted of a sexual offense. Respondents described private landlords being wary of the liability and the potential backlash from neighbors who find out about VCSOs living in their neighborhood. One caseworker explained how an initial housing placement success turned to failure. Five VCSOs were housed in a private rental property when a newspaper reported on it:
“The neighbors,” according to the caseworker, were, “all ashamed and they want them [the veterans] to leave that place, but before that happened, we were like, what a success, we actually housed five sex offenders which is so hard to do.
Access to sex offender treatment.
Limited access to treatment for sexual impulses was also an issue, beginning with the incarceration period, even though there is limited programming within the VA specific to sexual offenses. It was reported that treatment was often not available while incarcerated or, when it was, stigma made attending the groups difficult. One veteran explained that there was a therapy group he could participate in while incarcerated but people were reluctant to go. This was because they were required to leave their IDs outside of the door and other inmates would look through them to see who was required to be on the sex-offender registry. This participant reported that this opened him up to harassment by other inmates. He also described how the guards would give them a hard time for even holding the group, at one point telling them, “you don’t even deserve coffee.”
Stakeholders also reported a lack of mental health services to manage SO treatment following incarceration. Stakeholders reported that the VA runs two small groups in Massachusetts (8-10 people) that are treating VCSOs but these groups are hard to get into because of their limited size (this was corroborated by one of the stakeholders, a mental health clinician, who himself ran one of the groups). New group members were only permitted if an existing member left, which happened infrequently. Veterans involved in these groups reported they were very pleased with their therapy.
Sex offender classification and classification process.There are also several legal barriers to reintegration that can be navigated with appropriate assistance and knowledge, but often Veterans do not know how or when to do that. One of these barriers that occurs during incarceration is SO level assignment. Assignment happens when an incarcerated person is getting ready for release. Level assignment can greatly impact the restrictions that are placed on a veteran once they have left incarceration and thus their ability to reintegrate. Participants reported that, seemingly by default, most with a criminal history of sexual offenses were assigned level 3. According to stakeholders, that assignment can be appealed, something many people may not know. Veteran participants in our sample who did appeal their decision successfully had it lowered to a level 1. Participants noted that it was commonly through speaking with other fellow veteran inmates that they made their decision to appeal. Stakeholders reported that generally, inmates do not have legal counsel while incarcerated so they do not have formal advice when appealing their level decision. Once they initiate an appeal, however, they are appointed a lawyer who will help with the remainder of the appeals process. One stakeholder noted that if an individual decides to appeal their level after leaving incarceration it can be more difficult because they need a lawyer, and many cannot afford legal counsel.
Another classification issue that was reported by HCRV staff was the process of civil commitment. Civil commitment means being committed to a state psychiatric hospital for no defined amount of time (Massachusetts Legislature). Participants reported that not every reentry veteran may know that they can appeal the decision to have this hearing or, they may not appeal because participants reported that they felt that appealing was a hopeless endeavor. HCRV counselors reported that the civil commitment process made it difficult to make a reentry plan for these individuals because the counselor may have secured housing only to find out on the day the veteran is supposed to be released that they are being committed. Or, the date that the individual is supposed to get released gets pushed back so there can be a civil commitment hearing or to hear an appeal.
Facilitators to Reintegration
Identifying facilitators to reintegration may lead to development of interventions. The themes related to facilitators included access to care, knowledge about services, the ability to self-advocate, and strong social support (often provided by other veterans).
Access to sexual impulse treatment and other health care. Access to health care (medical and behavioral) while still in prison or jail was noted as having advantages over receiving care after release only. Some of this care was to address issues with their sexual offense and some of it was to assist with other mental health or medical problems. VCSOs described how in-facility treatment helped them to see themselves differently and gave them skills, such as understanding boundaries, to navigate life outside of incarceration and reducing the likelihood of reoffending with a sex offense. Veterans also described how having Alcoholics and Narcotics Anonymous groups inside prison and jail was “fantastic” and helped with recovery.
After release, access to SO treatment was equally important. While not every veteran described a positive experience with postincarceration therapy, all except two described therapy as a necessary outlet where they were able to discuss the issues they were facing and learn coping skills and the importance of the comradery of the VSCO group they attend. One veteran explained the benefits of SO therapy:
they offer you some positive, constructive feedback in a way that’s not saying that you shouldn’t feel that way, no, it’s healthy for you feel that way and then, they ask you how are you going to work through it? Instead of telling you how you are going to work through it.
While many were court mandated to attend sexual impulse therapy as part of a probation agreement, one of the stakeholders (a VA behavioral health provider) reported that VCSOs attending SO groups offered by the VA often continued therapy longer than what was required by courts.
Knowledge, self-advocacy, and hope.Having knowledge of the legal process and the ability to self-advocate was important for persons with all types of offenses, but it was particularly important for VCSOs to understand the significance of their SO level assignment and how to navigate the appeals process. In the months prior to leaving incarceration an individual convicted of a sexual offense receives a letter with their level assignment, including a form to appeal that level. Not every VCSO took advantage of this appeals process or necessarily understood what the form was for – even though getting a lower level can greatly ease reentry. The decision to appeal a SO level assignment was, for some veterans, attributed to self-advocacy. As one veteran described,
I felt under the new law, I had grounds for a lower number, and you should always appeal it…. You know you could win and say, even though it looks like you don’t have a shot in hell…. So, that’s what I live by, I don’t look at the top number; like eighty percent chance it’s not going to happen, I look at twenty percent that it is going to happen or one percent chance or whatever. Why can’t I fall in that category?
The concepts of self-advocacy and hope were important facilitators which we saw repeatedly eased the transition.
Upon release, a veteran has multiple, nearly simultaneous, needs, including securing housing and food, obtaining identification, enrolling in benefits, and opening a bank account. Having the ability and motivation to try to get help securing these essentials was a major facilitator to a successful reentry. As one veteran described,
When I get out, there was nobody gonna be standing there outside the gate of your jail waiting to pick me up, drive me home. “Oh we missed you!” It wasn’t happening. I’m on my own. What am I gonna do? Am I gonna wait? And then see what happens or am I gonna start taking advantage and start asking questions and reaching out. And I was like, I really don’t like sleeping on the street so I gotta really start getting involved in this and from the get-go.
Another veteran pointed out,
there are some food pantries and there are churches that give meals and so, but you got to do the foot work. You can’t sit on a park bench, downtown, and expect people to give you everything you need. You gotta be willing to you know, get a bus pass. That’s important and go places and be told, no, but if you are doing it right, you won’t be told no.
Other veterans discussed the importance of learning about where one was living (or going to live) and making sure the important resources were available. For example, they recommended living in a place that was on a bus line and near social/medical/mental health services so that they could have all the essential ingredients for a successful reentry. VCSO also described being advocates for their friends who were fellow reentry veterans who were also VCSOs. This helped them to form social networks, another important facilitator to reentry, described below. Many were involved with the National Association for Incarcerated Veterans and described this group as important for making social connections while incarcerated and, that these friendships were a source of knowledge that sometimes continued after incarceration.
Social support.
Social support, both formal and informal, can be a facilitator to successful reintegration. In the formal area, several veterans described how HCRV counselors helped with housing and medical appointments. Almost all veterans in our sample indicated they had met with an HCRV counselor while still incarcerated. These counselors often knew landlords who were more flexible and would take someone with a sex offense. Veterans and HCRV counselors also reported that one of the counselor’s roles prior to the veteran’s release was to help the veteran secure benefits and make medical appointments (that would take place after release).
Another formalized social support which was seen as facilitating reintegration was reentry class held in prisons and jails. Some of the class material (e.g., how to secure housing) was not very relevant to VCSOs because they face considerable restrictions on where they can live, but other aspects of the class were described positively. For instance, veterans reported learning how to make a budget, what things should cost at the grocery store, how to write a resume, how to conduct one’s self in an interview, and other life skills that assist with the transition. One criticism of the class however was the focus on employment. Many of the veterans in our sample were at or above retirement age and did not plan to work after release. The skills learned in reentry classes are intended to help veteran help themselves, reinforcing the importance of self-advocacy and hope.
Informal social support usually came from friends and family. Levels of informal social support varied, but all veterans described at least one social connection who was an important facilitator to successful reentry. These included family members, friends, fellow reentry veterans, religious organizations, and caseworkers. Several of these participants also lived with others VCSOs or formed friendships and support networks through in-patient and out-patient therapy. Veterans in our sample described how this support system had given them not only moral support but also helped them find housing, transportation, and employment.
Discussion
To our knowledge, this is one of the first qualitative efforts to describe the reentry experience for VCSOs. Our qualitative approach allowed us insights into the considerable barriers to community reintegration that are faced by VCSOs specifically. It was important to study this population specifically not only because they have unique characteristics but also because the VA can potentially target resources towards this population if their needs are better understood. Staff commented that they often felt ill-equipped to manage this population.
Consistent with the BVMP (Gelberg et al., 2000), we saw that predisposing characteristics such as age, combined with enabling characteristics, such as social support impacted the outcome of the reentry process. The most prominent barriers are stigma and limited housing options, both of which increase vulnerability in getting reestablished safely and productively. This is congruent with literature on the topic which shows that reentry planning is critical to community integration and reducing recidivism (Gwenda & Randolph, 2009; Zamble & Quinsey, 2001). These veterans carry a double burden upon release: having a criminal record and being registered as a SO. In addition to pervasive stigma and significant challenges to finding housing, other barriers faced by this sample of VCSOs included lack of social support, access to sexual impulse treatment, information about the sexual offense level assignment process and opportunities to appeal, and knowledge about resources and services. Below we describe opportunities for intervening, suggested by our data, to enhance the reintegration for those registered as a SO.
We found that stigma in particular was an overarching issue that permeated each step in the reentry process and contributed greatly to the limited housing options and dearth of social supports. While all justice involved individuals potentially experience stigma, even among this population those convicted of a sexual offense are particularly stigmatized (Tewksbury, 2012). Literature on the topic has shown that public fear those on the SO registry returning to communities and this has resulted in pickets, vigils, and evictions (Petrunik & Deutschmann, 2008). In the initial weeks and months after release the interrelated barriers of social isolation and stigma can impede community reintegration and lead to recidivism (Freeman-Longo, 1997; Gavrilets et al., 2016; Hanson & Bussiere, 1998; Levenson, 2008). This is demonstrated throughout the process map (Figure 1). Researchers at the VA recently deployed a peer supported intervention, which has the potential to help ameliorate social isolation and provide reentry veterans with practical support (Simmons et al., 2017). Peers are well positioned to assist veterans who require trauma informed care and improve outcomes among justice involved persons (Aos et al., 2006; Bagnall et al., 2015; Prendergast, 2009). Trauma informed care is needed among this population, which has a high likelihood of having been exposed to trauma both in childhood and the military (Blosnich et al., 2014; Finlay et al., 2019). Peers also develop relationships within the community which have potential to help in finding housing for VCSOs when none is available through the VA, due to restrictions on Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) vouchers (HUD-VASH vouchers are part of a supportive housing program jointly run by the Department of Housing and Urban Development and the VA). This is intervention points 3 and 4 in Figure 1.
Our data also show that psychological treatment is essential to help the veterans in our sample learn to navigate stigma, which in turn will lead to less social isolation and lower chances of recidivism. This is especially important for veterans because they are more likely to additionally suffer from mental illness, traumatic brain injury and substance use disorder (Olenick et al., 2015). In the postrelease period, health care settings provide an opportunity for intervention, especially when they provide opportunities for sexual offender treatment that can address underlying contributors that led to the individual committing a sexual offense. From our stakeholder interviews we identified 2 therapy groups in Massachusetts specifically for VCSOs. Participants in these groups reported that therapy had the additional benefit of helping them to navigate the stigma and social isolation of their SO status. Hanson and Bussiere (1998) demonstrated that this type of therapy is effective at reducing recidivism and therefore may be essential for those with pathologic impulse to commit crimes of a sexual nature. Increasing the availability of this type of treatment at VA medical centers would likely contribute to reducing recidivism. Due to the single payer health care status of the VA, this is a unique opportunity for veterans specifically. Some of the veterans in our sample also struggled with substance use disorder, and often substance use contributed to the sexual incident for which they were convicted. This would suggest that access to substance use disorder treatment is also an important component of initiatives to assist reentry VCSOs. Access to these services is important at intervention points 3 and 4 (Figure 1).
SO level assignment can also have a critical impact on reentry and more attention to this designation is needed. Being assigned a level 3 SO designation (which is a common default designation in Massachusetts often when not warranted, according to respondents) can make the attainment of housing, and many other aspects of reintegration more difficult. As respondents noted, those with a level 3 designation are placed on the life time SO list and cannot ever receive federal housing assistance (US Department of Housing and Urban Development, Office of Housing, Office of Public and Indian Housing, 2012). The public notification associated with this higher level assignment (e.g., a level 2 and 3) such as public online registries, may increase social isolation, depression, and anxiety, which can contribute to recidivism (Edwards & Hensley, 2001; Freeman-Longo, 1997; Hanson & Bussiere, 1998). Consistent with literature on the topic, respondents reported that some localities also have restrictions on where those on SO registries can live, for example not near schools or parks for level 2 or 3 offenders (Levenson, 2008; Levenson & Cotter, 2005). The veterans in our sample who appealed their level decision had it lowered. HCRV providers – who have contact with the veteran while he or she is incarcerated – would potentially be best suited to advise the reentry veteran about the appeals process (intervention point 1 on Figure 1). However, HCRV and the VA are prohibited from providing legal advice nationally (Department of Veterans Affairs, 2019). They are however allowed to refer the reentry veteran to pro-bono legal services. Appealing a decision post incarceration has traditionally been more difficult because the VCSO is responsible for their own legal fees and many cannot afford the process. However, a recent court case in Massachusetts overturned this restriction but it is unclear how this will impact how many people request an appeal.
Consistent with the literature (Petrunik & Deutschmann, 2008), our data show that housing is also a major barrier to successfully reentry that must be addressed (intervention point 3 on Figure 1). This may require state or federal intervention to either provide funding for housing assistance or to change regulations to open up more VA or state transitional housing to VCSOs. Additionally, while many municipalities in Massachusetts do not have prohibitions on VCSOs using housing vouchers for nonlifetime registrants, there are locations where this is not the case. Expanding access to these vouchers nationally may help to address some of the issues related to housing. Changes in housing policy have also been suggested by several studies which have looked specifically at residency restrictions for those on a SO registry (Mercado et al., 2008; Zgoba et al., 2008). A potential intermediary step is to provide education to housing providers so they better understand the low risk of housing individuals registered as SOs and the benefit providing housing may have. The VA has engaged in similar community development programs in the past (Department of Veterans Affairs, 2020). Research would be needed to determine if this might have an impact on housing availability for VCSOs specifically. VA hospital campuses which have housing should consider making more units open to VCSOs, especially when there are sexual offender treatment resources on site.
Another opportunity for intervention (intervention point 2 in Figure 1) is more targeted dissemination of information to veterans while still incarcerated. For example, this information may be provided during prerelease classes and during visits with HCRV and DOC counselors. Access to HCRV counselors, and the resources these counselors have access to, is unique for veterans. Most health care systems do not provide assistance tailored to the unique needs of persons recently released from incarceration as is done in the VA.
HCRV counselors can assist with creating a comprehensive reentry plan, which is critical to reducing recidivism (Gwenda & Randolph, 2009). This specifically addresses the barrier associated with lack of knowledge. Our data showed that there are some specific issues related to those on the SO list which are not covered in prerelease classes, such as appealing one’s SO level assignment or finding sexual impulse treatment groups. Likewise, some information presented in the typical prerelease classes is not useful for those who are on the SO registry, such as much of the content around securing housing – since the rules are so different for those on the SO list. For example, the information provided to the general inmate population about federal housing assistance was largely not suited for those who are registered SOs because they are often not eligible for that type of assistance. At the same time, veteran study participants reported feeling overwhelmed by the amount of information they were given in the release process. So, better-targeted information related to those who have to register as a SO might help with this reentry planning, and is concordant with literature demonstrating that poor reintegration planning can increase recidivism, thus decreasing public safety (Gwenda & Randolph, 2009). Veterans in our sample suggested an information packet specifically for this population might help address current knowledge gaps that those on a SO registry experience.
Strengths and Limitations
It should first be noted that the findings we produced should be taken in context of us as researchers with individual personal characteristics. Our interest in the well-being of veterans may encourage participants to be open and honest during interviews. At the same time participant responses may be tempered by the knowledge that we are researchers that work for the VA, despite assurances that data collected are private and confidential and that VA services were not contingent on participation in our study, nor would they be affected by any responses the participants gave.
This was a small qualitative study focused on male VCSOs, all White except for one Black, in a single Northeast state; thus, the findings may not generalize to females, Blacks, persons in other states, or to nonveterans. Although there are limitations to the generalizability of our findings, we believe there are likely to be commonalities in the reentry experience for many individuals (veterans and nonveterans) on a SO list. For instance, while state laws governing the management of those on the SO registry may vary, the experience of stigma and the need for social support at reentry are unlikely to change by state. As previously mentioned, our sample of VCSO was also all White except for one Black participant. While this one participant’s experience mirrored that of his white counterparts, there are potentially additional barriers other races may encounter that have not been fully explored in this study. There may be some differences in experience between veterans and nonveterans on the SO registry. For example, there are specific resources that support reentry for veterans that are not always available to nonveterans. However, there were significant barriers experienced by our study participants, meaning nonveterans have an even more difficult time reintegrating following incarceration.
The qualitative methods we employed have the benefit of producing a deep and rich understanding of the facilitators and barriers faced by this population. This allowed for unexpected information to be included in our data and gave us a richer context for understanding of our results. We also triangulated findings through multiple participants and collected information until data saturation was reached.
Conclusion
A greater understanding of the barriers and facilitators for VCSOs at each stage of the reentry process is essential to providing appropriate services to this population. Veterans have specific resources and needs so research on this population specifically was needed. The knowledge gained through this study can contribute to leveraging interventions to deliver the most appropriate assistance. This includes social support, access to housing, referral to legal services and treatment options targeted towards the needs of VCSOs. This not only improves the lives of those on SO registries but is also essential from a public health perspective. Communities are safer and healthier if those who have a history of sexual crimes live in stable housing, are employed, receive the medical and mental health care they need and are integrated into a social network (Hanson & Bussiere, 1998; Levenson, 2008).
Footnotes
Declaration of Conflicting Interests
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, under a Grant from the Health Services Research and Development Quality Enhancement Research Initiative, QUE 15-284. Also, Dr Simmons was supported by a VA Health Services Postdoctoral Fellowship.
