The Impact of Collateral Consequences on Help-Seeking and Help-Attainment for Behavioral Health Needs for Women with Criminal Records

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Project Summary Millions of women in the United States have a criminal record. Women with criminal records have high rates of behavioral health concerns, including post-traumatic stress disorder (PTSD), depressive symptoms, substance use problems, and suicidal ideation and attempts. They also experience some of the highest rates of interpersonal violence, including intimate partner violence and sexual assault, which are associated with and exacerbate women’s behavioral health concerns. In addition, they have low rates of receipt of needed behavioral health treatment and supportive services, such as victimization services. These gaps in care may be driven by dynamics of collateral consequences, i.e., forms of exclusion from resources, services, and opportunities due to the presence of a criminal record. Research is critically needed to address the growing behavioral health inequities for women with criminal records and to improve women’s help-seeking and help-attainment for needed behavioral health care and services. This proposed mixed-methods study builds upon existing empirical work and a theoretically driven framework of help-attainment. We will examine how behavioral health, interpersonal victimization, and collateral consequences shape help-seeking and help-attainment processes for treatment and services among adult women with criminal records. Our proposed study will utilize an exploratory sequential mixed-methods design in which findings from the first, quantitative phase will inform the design of a second, qualitative phase, with both phases informing the third qualitative phase. In Phase I, N=500 women ages 25 to 54 with criminal records will be recruited to complete a web-based survey. Our survey will include measures of behavioral health concerns, victimization experiences, and theory-guided measures regarding dynamics of collateral consequences and help-seeking and help-attainment for behavioral health needs. These data will be used to identify patterns in domains influencing women’s help-seeking and help-attainment. In Phase II, we will conduct individual interviews using the life history calendar with N=40 women with criminal records, a stratified purposeful sub-sample of women who completed the Phase 1 survey. We will explore women’s trajectories of help-seeking and help-attainment, including dynamics of collateral consequences. Our findings from Phase I and II will inform our interviews with service providers in Phase III. We will conduct semi-structured interviews with N=30 service providers who work in treatment and service settings with women with criminal records. We will elucidate their perspectives of organizational and provider-based barriers and facilitators that impact women’s help-seeking and help-attainment processes. The collective findings will identify novel facilitators to help- attainment and intervention directions to improve the behavioral health and wellbeing of women with criminal records.